Why is it difficult to implement e-health initiatives? A qualitative study
Open accessAbstract
BACKGROUND: The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. METHODS: We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT). RESULTS: Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization. CONCLUSIONS: Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.
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An interview study of NHS clinicians and managers using normalisation process theory identified that Choose and Book referral software was unpopular and little used, and suggested that the main barrier to uptake was poor interactional workability.
“An interview study of NHS clinicians and managers using normalisation process theory identified that Choose and Book referral software was unpopular and little used, and suggested that the main barrier to uptake was poor interactional workability, defined as 'the impact that a new technology has on interactions, particularly . . .consultations';”
PACS was popular and widely used because it scored highly on all four constructs of normalisation process theory.
“in contrast, Picture Archiving and Communication System (PACS; a digital image storage and retrieval package), was popular and widely used because it scored highly on all of the four constructs listed in the previous paragraph.19”
The eHealth Implementation Toolkit (e-HIT) is aimed specifically at eHealth interventions and has been developed for use by managers and other staff charged with implementing eHealth initiatives.
“A similar toolkit, the eHealth Implementation Toolkit (e-HIT), is aimed specifically at eHealth interventions and has been developed for use by managers and other staff charged with implementing eHealth initiatives (ie, implementers) [120-122].”
From Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress (2012) · cites this paper as [120]
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- Authors
- Murray, E., Burns, J., May, C., Finch, T., O'Donnell, C., Wallace, P., & Mair, F.
- Affiliations
- University College London (GB)
- London South Bank University (GB)
- University of Southampton (GB)
- Newcastle University (GB)
- University of Glasgow (GB)
- Corresponding author
- Murray, Elizabeth
- Venue
- Implementation Science
- Published
- 2011-01-19
- Volume
- 6
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3038974
- OpenAlex
- W2102259090
- Cited by
- 270
- References
- 51
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 18 · 2023: 12 · 2022: 16 · 2021: 12 · 2020: 22 · 2019: 21 · 2018: 27 · 2017: 15 · 2016: 23 · 2015: 27 · 2014: 25 · 2013: 19 · 2012: 13
- FWCI
- 30.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- National Institute for Health and Care Research
- National Institutes of Health
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Keywords
- eHealth implementation, implementation barriers and facilitators, business executives, Normalization Process Theory, PACS, primary-secondary care interface, organizational change, health information technology
- MeSH terms
- Attitude to Computers, Choice Behavior, Community Health Nursing, Data Collection, Diffusion of Innovation, United Kingdom, Humans, Interviews as Topic, Medical Informatics Applications, Models, Theoretical, Primary Health Care, Radiology Information Systems, Referral and Consultation, Organizational Case Studies, Qualitative Research
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