For healthcare professionals only


Evaluating computerised health information systems: Opportunities were missed

BMJ 2003; 327 doi: (Published 17 July 2003) Cite this as: BMJ 2003;327:162
  1. Warren J Winkelman (wwinkelm{at}, researcher
  1. Centre for Global eHealth Innovation, University Health Network, Toronto, ON M5G 2C4, Canada

    EDITOR—Littlejohns et al describe a failed attempt to implement a computerised information system among 42 hospitals in the Limpopo province of South Africa. They provide a typology of possible reasons for this failure, retrospectively summarising the lessons learnt.1

    Implementing an information system can be viewed as an organisational innovation process that contributes to the maintenance and improvement of its overall performance and effectiveness.2 Some users may find themselves in a greater position of power and influence with the introduction of access to previously impenetrable organisational information, while others who have traditionally enjoyed legitimate power may find their power eroded by the innovation. If this potential problem is not dealt with during the implementation process, these people could militate against the process through incomplete implementation, rejection, or even sabotage.3

    Littlejohns et al also viewed implementation as a clinical intervention and used randomised controlled trials of users as their study method to evaluate the system's effectiveness. Given that innovation implementation is a complex, longitudinal process entailing phases that evolve over time and comprise many layers of social interactions,4 this positivist research strategy seems misguided. Organisational learning and progressive user empowerment need to be accounted for in any information system evaluative framework in which both the user and the innovation are fluid and evolving. Real success may be achieved by iteratively recognising and accounting for the changes in human factors in organisations that arise during implementation. These include redistribution of responsibility, alteration in management structures, and changes in attitudes.3 Success also requires accounting for these phenomena in the chosen study methods.

    Thus, innovation process theory for examining implementation of information systems is particularly relevant to understanding the relation between inputs to and outputs from the system, including the actions of key stakeholders and their collective effects on overall organisational change.5

    See also editorial by Booth


    • Conflict of interests None declared


    View Abstract

    Log in

    Log in through your institution


    * For online subscription