A Socio-Technical Analysis of Barriers to Implementing a Clinical Information System in a Nursing Home

A Socio-Technical Analysis of Barriers to Implementing a Clinical Information System in a Nursing Home

Calvin Kalun Or (The University of Hong Kong, Hong Kong), Kaifeng Liu (The University of Hong Kong, Hong Kong) and Hailiang Wang (The University of Hong Kong, Hong Kong)
DOI: 10.4018/978-1-5225-5460-8.ch018


In this chapter, the authors aim to identify key barriers affecting the implementation of a clinical information system (CIS) in a nursing home from a socio-technical perspective. The data collected through field observations and semi-structured individual interviews were analyzed using the immersion/crystallization approach based on the Sittig-Singh healthcare socio-technical framework (HSTF). Three categories of implementation factors encompassing the eight HSTF dimensions were identified: infrastructure-based factors, process-based factors, and outcome-based factors. The authors extended the HSTF by proposing two additional dimensions: advocacy, promoting the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and adaptability, ensuring the ability of the system to adjust to emerging needs. This chapter expanded prior research and identified barriers related to why the nursing home CIS was abandoned. A knowledge base and recommendations are offered herein as a guide for future implementation strategies and policies in CIS initiatives.
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Understanding the interrelations between technical and social aspects, as emphasized by the socio-technical (ST) theory (Berg, Aarts, & van der Lei, 2003; Edwards, 1972), offers researchers, system developers, and health care providers a means to explore why the implementation of a technology fails. Up to now, many conceptual models derived from the ST theory have focused on the interrelations among system elements. For example, Edwards (1972) developed the SHEL model discussing four elements: software, hardware, environment, and liveware. Carayon et al. (2006) built the Systems Engineering Initiative for Patient Safety (SEIPS) model to emphasize the interactions among people, technology, environment, tasks, and organizations. Under the context of health informatics, Berg et al. (2003) suggested to put more attention on the interaction between technology and its social environment if wanting to better understand health information technology (HIT). Later, Harrison, Koppel, and Bar-Lev (2007) proposed the Interactive Socio-Technical Analysis (ISTA) framework which highlighted the complex-, emergent-, inter-relationships between the HIT, clinicians, and workflows within healthcare system. Nevertheless, as pointed by Sittig and Singh (2010), previous socio-technical models did not “break down the technology dimension into individual components to enable researchers to dissect out the causes of particular HIT implementation or use problems, or to help identify specific solutions”. Based on these findings, Sittig and Singh (2010) developed a comprehensive 8-dimensional healthcare socio-technical framework (HSTF) for studying HIT in complex adaptive healthcare systems. Based on previous studies (Sittig & Singh, 2010; Sittig et al., 2011; Sittig et al., 2010), the eight interdependent and inter-related dimensions are described below:

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