Evaluating computerised health information systems: hard lessons still to be learnt
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7394.860 (Published 19 April 2003) Cite this as: BMJ 2003;326:860
- Peter Littlejohns, professor (p.littlejohns@nice.nhs.uk)a,
- Jeremy C Wyatt, professorb,
- Linda Garvican, senior research fellowc
- a National Institute for Clinical Excellence, London WC2N 5HR
- b Knowledge Management Centre, School of Public Policy, University College London, London WC1H 9E2
- c St George's Hospital Medical School, London SW17 ORE
- Correspondence to: P Littlejohns
Enormous investment has gone into computerised hospital information systems worldwide. The estimated costs for each large hospital are about $50m (£33m), yet the overall benefits and costs of hospital information systems have rarely been assessed.1 When systems are evaluated, about three quarters are considered to have failed,2 and there is no evidence that they improve the productivity of health professionals.3
To generate information that is useful to decision makers, evaluations of hospital information systems need to be multidimensional, covering many aspects beyond technical functionality.4 A major new information and communication technology initiative in South Africa5 gave us the opportunity to evaluate the introduction of computerisation into a new environment. We describe how the project and its evaluation were set up and examine where the project went wrong. The lessons learnt are applicable to the installation of all hospital information systems.
Summary points
Implementation of a hospital information system in Limpopo Province, South Africa, failed
Problems arose because of inadequate infrastructure as well as with the functioning and implementation of the system
Evaluation using qualitative and quantitative methods showed that the reasons for failure were similar to those in computer projects in other countries
Reasons for failure included not ensuring users understood the reasons for implementation from the outset and underestimating the complexity of healthcare tasks
Those responsible for commissioning and implementing computerised systems need to heed the lessons learnt to avoid further waste of scarce health resources
Limpopo Province in South Africa
Development of the project
The project to install a computerised integrated hospital information system in Limpopo (Northern) Province (figure) was the biggest medical informatics project in Africa. The project was initiated in response to a national strategy to restructure health care after the 1994 elections. Changes included shifting resources from tertiary and secondary care to primary care, devolution of …