Design-Reality Gap Analysis of Health Information Systems Failure
Résumé
This study investigates the factors contributing to the failure of Health Information Systems (HIS) in a public hospital in South Africa. While HIS have the potential to improve healthcare delivery by integrating services and enhancing effectiveness, failures can lead to service interruptions, revenue loss, data loss, administrative difficulties, and reputational damage. Using semi-structured interviews with key stakeholders, we employed a hybrid data analysis approach combining deductive analysis based on the Design Reality Gap Model and inductive thematic analysis. Our findings highlight several factors contributing to HIS failures, including system capacity constraints, inadequate IT risk management, and critical skills gaps. Despite these challenges, end users perceive HIS positively and recommend its implementation for streamlining daily processes. This study underscores the importance of
addressing design-reality gaps to improve HIS outcomes in public healthcare settings.
Contenu complet
1. Introduction
Public healthcare institutions in South Africa continuously strive to transition from manual paper-based records management systems to Health Information Systems (HIS) and Electronic Health Records (EHRs) to improve efficiency and patient care [13]. However, transitioning from paper-based to electronic systems is significantly challenging, resulting in failed HIS implementations in healthcare facilities [29]. This case study focuses on a South African public hospital implementing a cutting-edge HIS to effectively manage the patient’s medical records. However, the HIS implementation encountered significant challenges that led to considerable disruption in healthcare services and financial losses for the hospital. The primary research question underpinning this research is: “What factors contribute to the failure of Health Information Systems (HIS) in South African public hospitals.” The next section of the paper will cover the literature review, followed by a discussion of the adopted theoretical framework. The following section will present the findings, a discussion of the findings, and the study's conclusion.
2. Literature Review
2.1. Health Information Systems (HIS)
HIS are digitized systems for managing, storing, and transmitting health-related information. They gather, analyze, and store patient medical and health outcome-related data [3, 4, 7]. HIS encompasses electronic health records (EHRs), medical decision-support systems (MDSS), telemedicine systems, health information exchanges (HIEs), and other instruments that aid in the management of patient care and population health by medical professionals. In addition to supporting quality enhancement, population health management, and research, HIS can provide analytical tools. These systems are crucial instruments for healthcare organizations and can enhance the treatment of patients, increase effectiveness, minimize errors in diagnosis, and minimize healthcare costs [4, 27]. Health Information Systems (HIS) are a major enabling factor in the health service delivery landscape. These systems, also known as health management information systems (HMIS), are used for processing and storing patient information. Health information systems are classified into EMR (electronic medical records) or EHR (electronic health records) [1, 11]
2.2. Benefits and Challenges of HIS
Use HIS can transform the health care system from a predominantly paper-based sector to one that uses clinical and other information to assist medical professionals in delivering superior treatment to patients. HIS also allow medical professionals to view comprehensive and reliable patient data, allowing them to make informed choices regarding treatment. This may contribute to improved patient outcomes and superior treatment quality [3, 41]. Adopting HIS may optimize administration tasks such as financial planning, financial administration, invoicing, collaboration among medical professionals, and maintaining patient records [5, 6, 20]. It has been proven to reduce the effort and time required to execute these tasks manually [7]. HIS further assists with collecting, administering, and analyzing health information, allowing hospitals to recognize trends and patterns and make informed choices to enhance patient treatment and results [11, 20, 22]. HIS also presents challenges, such as data security and privacy concerns, interoperability issues, and the need for ongoing maintenance and enhancements. The HIS contains sensitive personal data and needs to be regulated. The Protection of Personal Information Act (POPIA) governs how organizations securely gather, store, and transmit personal information. With the introduction of POPIA, HIS needs to ensure adequate controls are in place to mitigate the leakage of patient information. Cyber-attacks continue to rise, and perpetrators are finding sophisticated means to attack organizational systems. Most HIS are also adopting artificial intelligence, and attacks on Artificial Intelligence systems continue to increase [10, 19]. The challenges have added complexity to the implementation and maintenance of HIS due to the number of skills required to develop and maintain a compliant system, and therefore, implementation costs have escalated [15, 40].
3. Theoretical Framework
Makumbani & Tsibolane / Procedia Computer Science 00 (2024) 000–000 3 Prior research indicates that this concept can be used in design to analyze and resolve discrepancies between the intended design and the actual experience or implementation of a product, system, or service [2, 16, 18, 25]. The chosen model (shown in Figure 1) is particularly well-suited for this study. It effectively demonstrates the criticality of post-adoption expectations regarding information systems and the dynamic nature of these expectations as users accrue greater experience with the specific information system in question [8, 18, 28]. However, it is currently understood that the failure of Health Information Systems (HIS) is critical [27]. The study [17] , therefore, formulates and elaborates upon the theoretical constructs of the “Design-Reality Gap” framework.