CHAPTER ONE

1.0 INTRODUCTION

Introducing an innovation into an organization will evoke changes. In some cases these changes will be minor ones that hardly affect the organization and the people working in it. In other cases, those having to use the innovation might experience major changes. Among health care professionals, new innovations are predominantly judged by their direct value for patient care.2 Patient care information systems include hospital information systems, computerized or electronic medical record systems, or nursing documentation systems. Information systems with a practical utility for patient care or diagnostic procedures are relatively easily accepted, sometimes even without any scientific evidence of their value.2,3 However, systems that support the process of health care without being directly relevant to patient care are less easily accepted. In particular, attempts to introduce health care information systems that require data entry by health care providers have not always been successful.4–6

But what is successful? Complete refusal of users to use a system is certainly a failure, but often success remains undefined. Clearly, the determination of success depends on the setting, the objectives, and the stakeholders. Only a thorough evaluation study can show whether or not a specific system was successful in a specific setting. A wide range of attributes has been measured in evaluations of patient care information systems. These attributes vary from purely technical factors to outcome measures such as quality of care and from end-user evaluation to extent of diffusion into the organization. Which criteria predict success or failure is unclear, but it is likely that no single criterion can account for success or failure of an information system. Furthermore, each evaluation criterion must be measured in an appropriate way.

In 1995 van der Loo conducted a literature review to classify evaluation studies of information systems in health care.7 The primary objective was to get an insight into the variety of evaluation methods applied. In all, 76 studies published between 1974 and 1995 were included in the review. Many different performance measures or success factors were applied in the studies reviewed. The review’s main conclusion was that the evaluation methods and effect measures depended on the characteristics of the information system under evaluation. However, the range of identified evaluation methods and effect variables was broad for every type of system. Among the effect variables were costs, changes in time spent by patients and health care personnel, changes in care process, database usage, performance of users or the system, patient outcomes, job satisfaction, and the number of medical tests ordered. Several authors have suggested approaches to evaluating information technology in health care.8–10 These approaches concerned assessment of technical, sociological, and organizational impacts.8,9,11 A literature review by Delone and McLean in the field of management information systems aimed at identifying determinants for system success.1 They presented a framework with six dimensions of success.

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