Contextual implementation model: a framework for assisting clinical information system implementations.

Area of Science:

• Health Informatics
• Information Systems Research
• Clinical Workflow Analysis

Background:

• Existing clinical information system implementation models often lack empirical grounding or fail to adequately address the complexities of the clinical environment and user needs.
• Physician adoption of mandatory systems like computerized provider order entry (CPOE) presents unique challenges in healthcare settings.

Purpose of the Study:

• To present the CONTEXTual Implementation Model (CIM), a novel, data-driven model for clinical information system implementation.
• To explore physicians' test management work practices in relation to the mandatory use of a hospital-wide CPOE system.

Main Methods:

• Qualitative data were collected from four clinical units across two Australian teaching hospitals.
• Methods included non-participatory observation of physicians using CPOE (55 sessions) and interviews with healthcare professionals (28).
• Data analysis employed an iterative grounded approach by two independent researchers.

Main Results:

• A central theme of 'contextual differences' emerged, explaining variations in CPOE system usage among physicians.
• The CIM identifies three key contextual levels influencing CPOE adoption: organizational, clinical/departmental, and individual.
• Factors such as organizational culture, leadership, and work practices significantly impact physician attitudes and CPOE utilization.

Conclusions:

• The CIM offers a valuable 'contextual differences' perspective to enhance clinical information system implementation.
• This model serves as a framework to guide future implementations, promoting safe, efficient use and increasing physician uptake.
• Effective implementation strategies must consider the diverse contextual factors impacting healthcare professionals.