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The Challenge of Implementing Health Information Systems - a Case Study in Charlotte Maxeke Johannesburg Academic Hospital

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The Challenge of Implementing Health Information Systems - a Case Study in Charlotte Maxeke Johannesburg Academic Hospital The Challenge of Implementing Health Information Systems - a case study in Charlotte Maxeke Johannesburg Academic Hospital by Moilwa Denton Serobatse Thesis presented in fulfilment of the requirements for the degree of Master of Philosophy (Information and Knowledge Management) in the Faculty of Arts and Social Sciences at Stellenbosch University Supervisor: Dr D le Roux MARCH 2013 Stellenbosch University http://scholar.sun.ac.za DECLARATION: By submitting this thesis electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification. Date: 19 February 2013 Copyright © 2013 Stellenbosch University All rights reserved ii Stellenbosch University http://scholar.sun.ac.za Opsomming Die tesis ondersoek die faktore wat Gesondheidstelsels (HIC) ingewikkeld maak. Die fokus is op a) doeltreffendheid, en b) bruikbaarheid (uit gebruikersoogpunt). ‘n Gevallestudie word gemaak van ‘n stelsel wat onlangs by Chalotte Maxeke Johannesburg Akakdemiese Hospitaal in gebruik geneem is. Die eerste doelwit van die ondersoek was om die ingewikkeldheidsgraad van sodanige stelsels te probeer bepaal, en tweedens om die situasie in die hospitaal self te evalueer. In hoofstauk 1 word die agtergond en aanleiding tot die ondersoek uiteengesite, woel as die metodologiese keuses wat gemaak is. Hoofstuk 2 bied ‘n oorsig oor relevante literatuur ten ospigte van HIC. Dit is duidelik stlselontwikkeling riskant, onnodig duur en koersloos is as dit sonder ‘n duidelike metodologie geïmplementeer word. Verandering vind voortdurend plaas en die implementering van oprasionele doeltreffendheid mag vernadering in besigheidstrategie, informasiestelsels, kennisbestuur en processoriëntasie noodsaaklik maak. In hoofstuk 3 word bruikbaarheid ondersoek. Verskeie mediese instellings het soortgelyke stelsels in gebruik geneem, maar die bruikbaarheid daarvan is steeds onseker. Vir die doeleindes van hierdie tesis is ‘n eie evaluasiemetode ontwikkel en ‘n vraelys op grond daarvan opgestel. Hoofstuk 4 rapporteer die gevallestudie in Charlotte Maxeke Johannesburg Akademiese Horspitaal hospital. Datakolleksie, navorsingsafbakening en – beperkinge, sowel as vraelysresultate word aangebied. Hoofstuk 5 bespreek die implikasies en toepassings van HIC. Dit blyk dat die voordele van die stelsel slegs deur die pasiëntadministrasieafdeling geniet word. Alle ander afdeling gaan steeds voort met papiergebaseerde inligtingstelsels, aangevaul deur ad hoc gebruik van Excel en woordprossering. Die tesis kom tot die gevolgtrekking dat kliniese personeel avers is teen die gebruik van geoutomatiseerde informasiestelsels. iii Stellenbosch University http://scholar.sun.ac.za Summary This thesis investigates the complexities involved in Health Information Systems. The focus is on the factors of a) efficiency and b) usability. A case study is made of a recently implemented system in Charlotte Maxeke Johannesburg Academic hospital. The first objective of the research was to gain a deeper understanding of the complexities of Health Information Systems, and secondly to evaluate the situation at Charlotte Maxeke Johannesburg Academic Hospital. In Chapter 1 a detailed introduction of the thesis is offered. This includes, explaining what triggered the research, the objective of the research and the methodology used to conduct the research. In Chapter 2 the focus is on a literature review of Health Information Systems, system fundamentals and planning and implementation. It is clear that without a methodology, systems development becomes haphazard and subsequently a risky and expensive undertaking. While change is pervasive, introducing operational efficiencies sometimes may necessitate reviewing of information systems and business strategy, knowledge management and process orientation. In Chapter 3 the issue of usability is investigated. Several healthcare institutions have implemented information systems but evaluations of the usability of these systems are still under debate. For purposes of this research an evaluation method for system usability and survey questionnaires were developed. In Chapter 4 the case study of Charlotte Maxeke Johannesburg Academic Hospital is reported. The chapter also describes the data collection design, research limitations and delimitations, survey findings and interpretations. In Chapter 5 the implications and applications of Health Information Systems are discussed. After analysis of the survey results, it appears that the impact and benefits of the new Health Information System are only positive or realized in the patient administration division. The rest of the health professionals continue to manually capture clinical notes and other management information on pieces of papers, spread sheets and word documents. The thesis comes to the conclusion that despite widespread use of technology in other sectors, clinicians in hospitals do not use implemented automated systems. Implementation of systems is complex and problems associated with usability are not resolved and that traditional systems implementation methodologies may not apply. iv Stellenbosch University http://scholar.sun.ac.za ACKNOWLEDGEMENTS Thank you to the CEO of Charlotte Maxeke Johannesburg Academic Hospital for granting me permission to conduct the survey and allowing staff to participate and share information about the organization. Special thanks to Ms Val Williams who generously volunteered her time to assist with the distribution and collection of the survey questionnaires. I am further grateful to all people who have set time aside to respond to the survey list of questionnaires and their comments. I also wish to express my sincere appreciation to Prof Johann Kinghorn for his assistance during the latter stages of my research project in preparing this thesis, his patience and support is greatly valued. Finally, I would like to thank family for inspiration and encouragement, and especially Lunelle for her patience. v Stellenbosch University http://scholar.sun.ac.za Table of Contents Chapter 1 .................................................................................................................................. 1 Introduction ............................................................................................................................. 1 1.1 Health Information Systems.................................................................................... 1 1.2 The Research Project: Assumptions and Objectives ............................................... 2 1.3 Methodology and Research Design ........................................................................ 3 1.4 Thesis Layout .......................................................................................................... 4 Chapter 2 .................................................................................................................................. 5 Health Information Systems – a Literature Analysis ..................................................... 5 2.1 Introduction ............................................................................................................. 5 2.2 Planning, Design and Implementation of Health Information Systems ................. 6 2.2.1 Initiation ............................................................................................................................. 9 2.2.2 Analysis and Requirements .............................................................................................. 10 2.2.3 System Development ........................................................................................................ 10 2.2.4 System Implementation .................................................................................................... 11 2.2.5 System Maintenance ......................................................................................................... 13 2.3 Information Systems and Business Strategy ......................................................... 13 2.3.1 Introduction ...................................................................................................................... 13 2.3.2 Re-engineering work: Don’t automate, obliterate ............................................................ 14 2.3.3 Strategic Change ............................................................................................................... 17 2.3.4 The Demand for Creative Thinking ................................................................................. 23 2.3.5 Team Syntegrity - Building Alliances .............................................................................. 28 2.3.6 Knowledge Management and Process Orientation ........................................................... 31 2.4 Organisational Impacts of Health Care Information Systems .............................. 40 2.4.1 Decision Making .............................................................................................................. 40 2.4.2 Control .............................................................................................................................. 41 2.4.3 Increased User Productivity and Efficiency ..................................................................... 41 2.4.4
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