Skip to main content
SpringerLink
Log in

Prioritizing Barriers to Successful Implementation of Hospital Information Systems

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Hospital information systems (HIS) are often implemented to enhance the quality of care, as well as to improve the efficiency and safety of health care services. However, there are various barriers for their successful implementation. The aim of this paper is to prioritize these barriers. This research is a cross sectional analytic-descriptive study. The study populations were hospital managers, IT department administrators, and clinical supervisors at the academic and non-academic hospitals of two cities in Iran. The data was collected by a questionnaire that its content validity was confirmed by three specialists. Its reliability was confirmed using Cronbach’s alpha (α = 0.78). Questionnaire contained five dimensions and 39 implementation barriers. The collected data was analyzed by descriptive and analytical statistics using the Kendall Rank Correlation Coefficient and Chi2 tests. The findings of the study revealed that lack of powerful information networks, error in data entry, technical problems related to system design, lack of organizational training, lack of users’ knowledge about system and working with it, and negative attitudes of providers and patients toward systems are the most important barriers of HIS implementation. Prioritizing of these barriers helps policy makers to decide what to do when planning for HIS utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee, H. W., Ramayah, T., and Zakaria, N., External factors in hospital information system (HIS) adoption model: a case on Malaysia. Journal of medical systems 36(4):2129–2140, 2012. doi:10.1007/s10916-011-9675-4.

    Article  Google Scholar 

  2. Kuhn, K. A., and Giuse, D. A., From hospital information systems to health information systems. Problems, challenges, perspectives. Methods of information in medicine 40(4):275–287, 2001.

    Google Scholar 

  3. Rahimi, B., Vimarlund, V., and Timpka, T., Health information system implementation: a qualitative meta-analysis. Journal of medical systems 33(5):359–368, 2009.

    Article  Google Scholar 

  4. Burton LC, Anderson GF, Kues IW (2004) Using electronic health records to help coordinate care. The Milbank quarterly 82 (3):457–481, table of contents. doi:10.1111/j.0887-378X.2004.00318.x

  5. Safran, C., msJAMA. Electronic medical records: a decade of experience. JAMA : the journal of the American Medical Association 285(13):1766, 2001.

    Article  Google Scholar 

  6. Salehinajad, S., Ahmaidn, L., and Khajouei, R., Affects of Health Information Systems in Iran: a Systematic Review. Journal of health information management 11(2):270–284, 2014.

    Google Scholar 

  7. Mandl, K. D., and Lee, T. H., Integrating medical informatics and health services research: the need for dual training at the clinical health systems and policy levels. Journal of the American Medical Informatics Association : JAMIA 9(2):127–132, 2002.

    Article  Google Scholar 

  8. Or, C., Dohan, M., and Tan, J., Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective. Journal of medical systems 38(9):99, 2014. doi:10.1007/s10916-014-0099-9.

    Article  Google Scholar 

  9. Munson, S. A., Cavusoglu, H., Frisch, L., and Fels, S., Sociotechnical challenges and progress in using social media for health. Journal of medical Internet research 15(10):e226, 2013. doi:10.2196/jmir.2792.

    Article  Google Scholar 

  10. Lai, H. M., Lin, I. C., and Tseng, L. T., High-level managers’ considerations for RFID adoption in hospitals: an empirical study in Taiwan. Journal of medical systems 38(2):3, 2014. doi:10.1007/s10916-013-0003-z.

    Article  Google Scholar 

  11. Tung, F. C., Chang, S. C., and Chou, C. M., An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical industry. International journal of medical informatics 77(5):324–335, 2008. doi:10.1016/j.ijmedinf.2007.06.006.

    Article  Google Scholar 

  12. Wang, B. B., Wan, T. T., Burke, D. E., Bazzoli, G. J., and Lin, B. Y., Factors influencing health information system adoption in American hospitals. Health care management review 30(1):44–51, 2005.

    Article  Google Scholar 

  13. Anderson, J. G., Social, ethical and legal barriers to e-health. International journal of medical informatics 76(5–6):480–483, 2007. doi:10.1016/j.ijmedinf.2006.09.016.

    Article  Google Scholar 

  14. Alkraiji, A., Jackson, T., and Murray, I., Barriers to the widespread adoption of health data standards: an exploratory qualitative study in tertiary healthcare organizations in Saudi Arabia. Journal of medical systems 37(2):9895, 2013. doi:10.1007/s10916-012-9895-2.

    Article  Google Scholar 

  15. Legare, F., Ratte, S., Gravel, K., and Graham, I. D., Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient education and counseling 73(3):526–535, 2008. doi:10.1016/j.pec.2008.07.018.

    Article  Google Scholar 

  16. Hayajneh SA, Zaghloul AA Barriers to the Adoption of Health Information Technology in Arab Countries’ Hospitals: Practitioners’ Perspective. In: Mantas J (ed) 24th International Conference of the European Federation for Medical Informatics Quality of Life through Quality of Information –MIE2012, 2012.

  17. Gravel, K., Legare, F., and Graham, I. D., Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions. Implementation science : IS 1:16, 2006. doi:10.1186/1748-5908-1-16.

    Article  Google Scholar 

  18. Guindon, G. E., Lavis, J. N., Becerra-Posada, F., Malek-Afzali, H., Shi, G., Yesudian, C. A., and Hoffman, S. J., Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 182(9):E362–372, 2010. doi:10.1503/cmaj.081165.

    Article  Google Scholar 

  19. Anvar, F., and Shamim, A., Barriers in adoption of health information technology in developing societies. International Journal of Advanced Computer Science 2(8):40–45, 2011.

    Google Scholar 

  20. Rahimi B, Moberg A, Timpka T, Vimarlund V (2008) Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium:616–620

  21. Laerum, H., Karlsen, T. H., and Faxvaag, A., Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report. BMC medical informatics and decision making 4:18, 2004. doi:10.1186/1472-6947-4-18.

    Article  Google Scholar 

  22. Simon, S. R., Kaushal, R., Cleary, P. D., Jenter, C. A., Volk, L. A., Poon, E. G., Orav, E. J., Lo, H. G., Williams, D. H., and Bates, D. W., Correlates of electronic health record adoption in office practices: a statewide survey. Journal of the American Medical Informatics Association : JAMIA 14(1):110–117, 2007. doi:10.1197/jamia.M2187.

    Article  Google Scholar 

  23. McGinn, C. A., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., Leduc, Y., Legare, F., and Gagnon, M. P., Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC medicine 9:46, 2011. doi:10.1186/1741-7015-9-46.

    Article  Google Scholar 

  24. Khajouei, R., and Jaspers, M. W., The impact of CPOE medication systems’ design aspects on usability, workflow and medication orders: a systematic review. Methods of information in medicine 49(1):3–19, 2010. doi:10.3414/me0630.

    Google Scholar 

  25. Nabovati, E., Vakili-Arki, H., Eslami, S., and Khajouei, R., Usability evaluation of Laboratory and Radiology Information Systems integrated into a hospital information system. Journal of medical systems 38(4):35, 2014. doi:10.1007/s10916-014-0035-z.

    Article  Google Scholar 

  26. Berg, M., Implementing information systems in health care organizations: myths and challenges. International journal of medical informatics 64(2–3):143–156, 2001.

    Article  Google Scholar 

  27. Berg, M., Patient care information systems and health care work: a sociotechnical approach. International journal of medical informatics 55(2):87–101, 1999.

    Article  Google Scholar 

  28. Loomis, G. A., Ries, J. S., Saywell, R. M., Jr., and Thakker, N. R., If electronic medical records are so great, why aren't family physicians using them? The Journal of family practice 51(7):636–641, 2002.

    Google Scholar 

  29. Walsh, S. H., The clinician's perspective on electronic health records and how they can affect patient care. BMJ (Clinical research ed) 328(7449):1184–1187, 2004. doi:10.1136/bmj.328.7449.1184.

    Article  Google Scholar 

  30. Castillo, V. H., Martinez-Garcia, A. I., and Pulido, J. R., A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC medical informatics and decision making 10:60, 2010. doi:10.1186/1472-6947-10-60.

    Article  Google Scholar 

  31. Boonstra, A., and Broekhuis, M., Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC health services research 10:231, 2010. doi:10.1186/1472-6963-10-231.

    Article  Google Scholar 

  32. Simon, S. R., McCarthy, M. L., Kaushal, R., Jenter, C. A., Volk, L. A., Poon, E. G., Yee, K. C., Orav, E. J., Williams, D. H., and Bates, D. W., Electronic health records: which practices have them, and how are clinicians using them? Journal of evaluation in clinical practice 14(1):43–47, 2008. doi:10.1111/j.1365-2753.2007.00787.x.

    Article  Google Scholar 

  33. Hsu, H. M., Hou, Y. H., Chang, I. C., and Yen, D. C., Factors influencing computer literacy of Taiwan and South Korea nurses. Journal of medical systems 33(2):133–139, 2009.

    Article  Google Scholar 

  34. Alasmary, M., El Metwally, A., and Househ, M., The association between computer literacy and training on clinical productivity and user satisfaction in using the electronic medical record in Saudi Arabia. Journal of medical systems 38(8):69, 2014. doi:10.1007/s10916-014-0069-2.

    Article  Google Scholar 

  35. Trivedi, M. H., Daly, E. J., Kern, J. K., Grannemann, B. D., Sunderajan, P., and Claassen, C. A., Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in “real world” clinical settings. BMC medical informatics and decision making 9:6, 2009. doi:10.1186/1472-6947-9-6.

    Article  Google Scholar 

  36. Urowitz, S., Wiljer, D., Apatu, E., Eysenbach, G., Delenardo, C., Harth, T., Pai, H., and Leonard, K. J., Is Canada ready for patient accessible electronic health records? A national scan. BMC medical informatics and decision making 8:33, 2008. doi:10.1186/1472-6947-8-33.

    Article  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge managers, IT department administrators and clinical supervisors who participated in this study. We would also like to thank experts who provided inputs for the revision of the questionnaire.

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

    Leila Ahmadian

  2. Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

    Reza Khajouei

  3. Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

    Simin Salehi Nejad

  4. BSc in Health Information Technology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

    Maryam Ebrahimzadeh

  5. Department of Management and Health Information Technology, Faculty of Management and Health Information Sciences, Kerman University of Medical Sciences, Kerman, Iran

    Leila Ahmadian, Reza Khajouei & Somayeh Ezhari Nikkar

  6. Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-bagh Highway, PO Box: 7616911320, Kerman, Iran

    Reza Khajouei

Authors
  1. Leila Ahmadian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reza Khajouei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simin Salehi Nejad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maryam Ebrahimzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Somayeh Ezhari Nikkar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reza Khajouei.

Additional information

This article is part of the Topical Collection on Systems-Level Quality Improvement

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmadian, L., Khajouei, R., Nejad, S.S. et al. Prioritizing Barriers to Successful Implementation of Hospital Information Systems. J Med Syst 38, 151 (2014). https://doi.org/10.1007/s10916-014-0151-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10916-014-0151-9

Keywords

Search

Navigation