Empirical Evidence of Resistance to the Implementation of Electronic Prescription in Brazil

Empirical Evidence of Resistance to the Implementation of Electronic Prescription in Brazil

Luiz Antonio Joia, Carlos Magalhães
DOI: 10.4018/978-1-61520-670-4.ch018
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This research investigates the main causes for the unsuccessful implementation of an electronic prescription system in a general hospital – from an explanatory-exploratory case study standpoint – adopting resistance to information systems as its theoretical background. In the case under analysis, the study shows that the main motives for resistance to the system were: lack of training of the physicians; the age of the physicians; problems with the design and safety of the system; inadequate technological infrastructure; the employment relationship of the physicians; and the interference of the system with the power and autonomy of the physicians. The chapter concludes that the intra-organizational context of the hospitals must be analyzed in a systemic way in order to understand fully how the system will be accepted and used by its main potential users, namely physicians.
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Over the past few years hospital organizations have taken advantage of the opportunities provided by Information Technology to improve the quality and efficiency of their internal processes and develop new types of health services. To a certain extent this development is due to increased use of the Internet in activities such as providing information about diseases, clinical diagnostic services, electronic individual patient medical record charts, remote monitoring of patients and surgical intervention at a distance.

However, research has shown that many of these above-mentioned undertakings have not achieved the desired objectives (see, for example: Lapointe et al., 2002; Paré, 2002; Lapointe & Rivard, 2005; Tan, 2005; Horan et al., 2005).

Within this context, this article was prepared in order to list some lessons learned from the unsuccessful implementation of an electronic prescription system in a hospital. The system had been developed specifically to speed up the physician’s prescription process and the delivery of medication to patients, as well as reduce costs relating to the use of paper.

In order to achieve this objective a case study was developed seeking to analyze the electronic prescription system of the Silvestre Adventist Hospital (HAS) in Rio de Janeiro, Brazil. Detailed analysis of this unsuccessful case vis-à-vis resistance to Information Systems enabled the authors to pinpoint the factors that were responsible for the below-average results of such implementation.

Consequently, the initially-established research question is: “Based on the case study under analysis and resistance to information systems, why was the implementation of an electronic prescription system in the hospital under scrutiny unsuccessful?”

Key Terms in this Chapter

Electronic Prescription: Prescription of medication within a computerized system.

Resistance to Information Systems: All instances both of non-usage and of inadequate use of information systems by the potential users of same.

TAM (Technology Acceptance Model): An information systems theory that models how users come to accept and use a technology.

Socio-technical approach: An approach to complex organizational work design that recognizes the interaction between people and technology in workplaces.

PAC S (Picture Archiving and Communication System): Computers or networks dedicated to the storage, retrieval, distribution and presentation of medical images.

E-Health: Set of activities in the medical area that makes use of the resources offered by the Internet for the purpose of achieving greater interaction between patients, organizations and professionals in the medical area.

TPB (Theory of Planned Behavior): A theory about the link between attitudes and behavior that has been applied to studies of the relations among beliefs, attitudes, behavioural intentions and behaviors in various fields such as advertising, public relations, campaigns, healthcare.

Tele-Homecare: Application of information and communication technologies to enable effective delivery and management of health services.

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