Implementing HIT—problems and challenges: A case study from a Turkish hospital

Research showed that health information technology (HIT) applications reduce clinical errors, support healthcare professionals, increase the efficiency of care and improve quality of care. However, there is some research which reveals negative effects of HIT on care practitioners and the risk of HIT implementations for hospitals. Moreover, HIT applications cost about 4.6% of the budget of healthcare enterprises and most of the time is not successful. In this paper, a HIT implementation process of a Turkish hospital was observed and analyzed. The aim was to the design a road map for hospitals which are going to implement HIT applications in order to minimize risks and to increase the chance for success. The hospital was going to replace its current HIT due to deficiencies such as no integration possibility for new IT applications (e.g. PACS, CPOE, etc.). 20 days after the HIT implementation, the system was totally abandoned because of too many problems. The analysis included observations of several nursing units, healthcare services as well as interviews with healthcare professionals and hospital managers. According to interviews and the observation, the biggest problems of the replaced HIS implementation in the hospital were found to be (1) inconsistency between workflows in the new system and former workflows. For example, the orders for the weekends were usually given on Fridays because only one physician was present at weekends to give orders for 24 patients but the new system allowed only daily orders. (2) There was lack of plans for data transfer and pilot applications. They had problems with current patients’ care since the current patients’ data could not be transferred to the new system. Data from the old appointment making service was not transferred to the new system when the new one started. All patients’ appointments were lost on first day when the new system went online. Moreover, the new system became active on a Monday when the hospital usually was most crowded. This caused even more chaos. Some forms (e.g. dispatch to another hospital/clinics) were found not to be defined in the new system. Nevertheless, a pilot test of the new HIT was done—but only in ER. Since ER did not use these forms, the missing forms were not realized during the test phase. The lessons learned from the case study are used for designing a roadmap for more successful HIT implementations. HIT projects require and result in change of the clinicians’ work flows. Current hospital and health care work flows should be recorded for a status quo analysis. By implementing the new HIT into those work flows, weak points and implementation failures can be made visible. C3-modeling is found to be an optimal tool to describe current weakly structured work processes and to design new work processes under the influence of a new technology for a successful implementation of HIT. A deeper understanding of the implementation procedure and its consequences will lead to a higher awareness for risks and ramp up problems. Partial tests in all relevant units, focus group discussions and interviews before and during tests help to minimize the failure risk. Users can be better prepared if work flows after the implementation are discussed and are pre-defined by the concerned units. Thus, the hospital management together with the HIT vendor prepares the users for the HIT implementation. Last but not least, risk analyses should be conducted to estimate the chance for a successful implementation. For this purpose, fuzzy risk modeling is found to be most appropriate tool.