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Evaluation of User Adoption during Three Module Deployments of Region-wide Electronic Patient Record Systems
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
2014 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 83, no 6, 438-449 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

In Sweden there are modular region-wide EPR systems that are implemented at various health organisations in the region. The market is dominated by four IT systems that have been procured and deployed in 18 out of 21 regions.

METHODS:

In a 2.5-year research study, deployments of three region-wide EPR modules: a patient administration system, eReferral module and eMedication module were followed and evaluated. Health professionals, EPR maintenance organisation, IT and health care managers were observed, interviewed and responded to questionnaires.

RESULTS:

Although the same deployment process was used during the three deployments, large variations in the units' adoptions were observed. The variations were due to: (1) expectation and attitude, (2) management and steering, (3) end-user involvement, (4) EPR learning, and (5) usability and the possibility of changing and improving the EPR.

CONCLUSIONS:

If changes in work processes are not considered in development and deployment, the potential benefits will not be achieved. It is therefore crucial that EPR deployment is conceived as organisational development. Users must be supported not just before and during the go-live phase, but also in the post-period. A problem often encountered is that it is difficult to make late changes in a region-wide EPR, and it is an open question whether it is possible to talk about a successful deployment if the usability of the introduced system is low.

Place, publisher, year, edition, pages
2014. Vol. 83, no 6, 438-449 p.
National Category
Human Computer Interaction
Research subject
Human-Computer Interaction; Medical Informatics
Identifiers
URN: urn:nbn:se:uu:diva-196508DOI: 10.1016/j.ijmedinf.2014.02.003ISI: 000335903400005PubMedID: 24630924OAI: oai:DiVA.org:uu-196508DiVA: diva2:610295
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Evolving Systems – Engaged Users: Key Principles for Improving Region-wide Health IT Adoption
Open this publication in new window or tab >>Evolving Systems – Engaged Users: Key Principles for Improving Region-wide Health IT Adoption
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many countries have formulated their eHealth visions and billions of dollars have been spent on supporting the eHealth development throughout the world. An important part of the development is the electronic patient record (EPR). To enable sharing and increase cooperation between care providers, most Swedish county councils have decided to use a region-wide EPR. The health professionals often experience numerous problems and consider the region-wide EPR to be too generic and require them to tailor their practices instead of the system evolving towards supporting their needs.

The aim of the PhD research is to gain knowledge of adoption when deploying and using region-wide health IT systems. This is accomplished by studying, analysing and reflecting upon what region-wide health IT systems are and how professionals use them in their practice. In the research a grounded theory method has been used, which means that the empirical data, not theories and hypotheses, have driven the research process. The data-gathering methods have been interviews, observations, participating in meetings, questionnaires, seminars and conducting literature reviews.

In order to be able to improve the adoption, a set of four key principles has been identified: (1) Evolving systems-Engaged users, (2) Treat IT deployment and usage as part of organisational development, (3) Identify, respect and support differences, and (4) Identify what must be customised and what can be centralised.

These four principles challenge the traditional way of developing enterprise-wide IT and emphasise the importance that users must engage in the development, procurement and deployment process to identify their similar and unique needs and procedures. It is crucial that both the similarities and uniqueness are respected and supported. The similarities can be supported by a centralised, standardised solution, while uniqueness requires a customised solution. In order to accomplish that, the IT deployment and usage needs to be treated as an important part of the on-going organisational development, and the IT systems must evolve, i.e., be continuously developed in order to engage the users to participate. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 1030
Keyword
HCI, eHealth, EPR, sociotechnical systems, enterprise-wide systems, deployment, change management, usability, health care
National Category
Human Computer Interaction
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-196510 (URN)978-91-554-8623-5 (ISBN)
Public defence
2013-05-24, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:30 (Swedish)
Opponent
Supervisors
Available from: 2013-05-02 Created: 2013-03-11 Last updated: 2014-07-21Bibliographically approved
2. Change and resistance to change in health care: Inertia in sociotechnical systems
Open this publication in new window or tab >>Change and resistance to change in health care: Inertia in sociotechnical systems
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis explores change and resistance to change of IT systems in organisations from a sociotechnical perspective. The work is drawing on empirical data gathered during two Action Research projects in Swedish Health Care: one regarding the deployment of electronic patient record systems within health care organisations, and the other regarding the deployment of eHealth services geared towards patients and citizens. Resistance to change is classified as an indicator of social inertia, and the concept of counter-implementation, comprising three general strategies to obstruct change initiatives, is used to highlight the political aspects of social inertia. For the analysis, the concept of social inertia is used as a point of departure towards inertia in sociotechnical systems by applying values and principles from sociotechnical systems research, most prominently the interdependence-characteristic. This extended concept is used to show and discuss how IT systems can either enforce change or be a source of inertia preventing change in organisations, and such planned or inadvertent effects of implementing IT systems are discussed as a significant source of user resistance.

Place, publisher, year, edition, pages
Uppsala University, 2014
Series
Information technology licentiate theses: Licentiate theses from the Department of Information Technology, ISSN 1404-5117 ; 2014-005
National Category
Human Computer Interaction
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-224862 (URN)
Presentation
2014-06-13, Room 2446, Polacksbacken, Lägerhyddsvägen 2, Uppsala, 13:15 (English)
Supervisors
Funder
VINNOVA, 2012-02233
Available from: 2014-06-13 Created: 2014-05-22 Last updated: 2017-08-31Bibliographically approved
3. Inertia in Sociotechnical Systems: On IT-related Change Processes in Organisations
Open this publication in new window or tab >>Inertia in Sociotechnical Systems: On IT-related Change Processes in Organisations
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The introduction of new information technology (IT) in an organisation is one way of changing the conditions for how tasks and work processes can be designed and performed, as well as how people in the organisation interact with each other. Today, many Swedish workers rely completely on IT to be able to perform their jobs, while experiencing a combination of continuous and intermittent IT-related changes that affect this ability.

The introduction of new or updated IT systems in an organisation is an example of what is referred to as an IT-related change process in this thesis. Because IT has become such an integral part of modern organisations, many change processes in organisations are simultaneously enabled and constrained by the IT systems involved in a change process. In this thesis, I introduce the concept of inertia in sociotechnical systems to analyse IT-related change processes in organisations, and how achieving the goals of these processes is complicated by organisational, social, and physical aspects in addition to technology.

The context of this thesis is the Swedish public sector domains of health-care and higher education, and the result of research studies and experiences from four action research projects in these settings. The contribution of this thesis adds to the contributions of the included papers through the definition of inertia in sociotechnical systems and its subsequent application. The thesis shows that the concept of inertia in sociotechnical systems can be used to understand IT-related change processes as changes to the characteristics of a sociotechnical system, and, in the context of organisations, how these processes affect and are affected by an organisation’s characteristics. This is illustrated in the thesis through the application of the concept on examples of IT-related change processes from the included papers and research projects. In addition, the thesis shows that the use of vision seminar methods can benefit Swedish organisations, since new IT is often introduced without clearly defined, expressed, understood, and accepted goals.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 86 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 1531
Keyword
Human-Computer Interaction, User-Centred Design, Participatory Design, Organisational Change, IT-related Change Processes, Action Research, Inertia, Sociotechnical Systems, Vision Seminars
National Category
Human Computer Interaction
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-326799 (URN)978-91-513-0010-8 (ISBN)
Public defence
2017-09-15, ITC 2446, Polacksbacken, hus 2, Lägerhyddsv. 2, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2017-08-24 Created: 2017-07-29 Last updated: 2017-09-08

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Janols, RebeckaLind, ThomasGöransson, BengtSandblad, Bengt

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