Hospital Information System Implementations- Delays and Failures

Implementing HIS solutions in hospitals can be quite a challenge ! Implementing HIS in hospitals is not a mere computerization of the hospital. It is just not about automating the existing paper trail but about implementing proper business processes, reengineering and tweaking the current workflows and implementing global best practices in order to improve effectiveness and efficiency of the hospital to provide better patient care. Hospitals begin with automation of most manual processes at one go leading to either failure of the implementation or transfer of the inefficiencies of the manual system to the computerized environment. HIS upgrades and new implementations may take several months to years to become completely functional depending on the hospitals computerization requirements. The hospital management is not well versed with the project planning and project tracking tools and techniques to monitor the HIS implementation project status and handle failures and nonconformance as they occur. What lacks also is the committed involvement of the top management of a hospital and assiduous training of the actual end users such as the front office staff (doing registration, admission, OP appointment scheduling), paramedical staff, nurses, doctors, support staff (maintenance, laundry, kitchen, housekeeping), finance, inventory, purchase and supply staff to ensure success of implementation of HIS in any hospital. It is also of utmost importance that the right vision and mission for HIS implementation project is articulated and communicated to the IT Company providing the HIS software, which again lacks either totally or partially.

Some of the major reasons for delays and failures in implementation of information systems in hospitals are:

•   hospitals lack information about healthcare IT solutions, capabilities of computerization;
•  administrative needs of the hospital are sometimes not studied or collected from the hospital administration and users of administrative functions;
•   proper study and consolidation of problem and pain areas in the hospital is not conducted prior to assimilation of computerization needs of the hospital;
•   lack of consensus is commonly seen between HIS and healthcare IT solutions provider and hospital on implementation processes to be followed;
•  lack of preparedness from the hospital for reengineering of processes;
•  administrative and clinical leadership are insufficiently aware of how big a change this would be;
•  failure to do necessary preparation with key stakeholders;
•  failure to sufficiently engage both administrative and clinical leadership;
•  going live too fast and early e.g. turning on whole hospital at once is a big pitfall which most HIS implementations commit;
•  trying to fix previously existing policy problems at the time you implement;
•  making clinical decision support systems operational at the very onset. It’s better to phase in;
•  failure to provide users an easy mechanism for reporting on-going problems;
•  failure to make sufficient changes to application;
•  failure to devote sufficient resources to making changes to the application;
•  insufficient support for the underlying system;

              – inability to keep network up to speed;

              – lack of enough terminals;

•  lack of end user contribution;
•  lack of integration of different information systems, external systems and independent physician groups;
•  struggle to strike a balance amongst different departments and end users;
•  redundant, inaccurate, uninformative or confusing master data;
•  lack of standardization of data definitions, representation and vocabulary;
•  lack of technical requirements planning;
•  lack of end user training;
•  improper management of resistance from end users;
•  software immaturity; and
•  inadequate post implementation support from vendor.

Authored by- Ms. Ranjeeta Basra Korgaonkar (Assistant Professor, International Institute of Health Management Research, New Delhi, India)