Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center
Open Access
- 1 May 2004
- journal article
- Published by Oxford University Press (OUP) in Journal of the American Medical Informatics Association
- Vol. 11 (3), 207-216
- https://doi.org/10.1197/jamia.m1372
Abstract
Most studies of the impact of information systems in organizations tend to see the implementation process as a “rollout” of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of “emergent change,” they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus.Keywords
This publication has 23 references indexed in Scilit:
- The Search for Synergy: Interrelating Medical Work and Patient Care Information SystemsMethods of Information in Medicine, 2003
- Order Creation and Communication in HealthcareMethods of Information in Medicine, 2003
- Crossing the Quality Chasm: A New Health System for the 21st CenturyJournal for Healthcare Quality, 2002
- Using Technology and Constituting Structures: A Practice Lens for Studying Technology in OrganizationsOrganization Science, 2000
- Managing Change: An OverviewJournal of the American Medical Informatics Association, 2000
- Managing Change: Analysis of a Hypothetical CaseJournal of the American Medical Informatics Association, 2000
- Information Technology in Complex Health Services: Organizational Impediments to Successful Technology Transfer and DiffusionJournal of the American Medical Informatics Association, 1997
- Addressing Organizational Issues into the Evaluation of Medical SystemsJournal of the American Medical Informatics Association, 1997
- Improvising Organizational Transformation Over Time: A Situated Change PerspectiveInformation Systems Research, 1996
- Computer-based Physician Order Entry: The State of the ArtJournal of the American Medical Informatics Association, 1994