Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center
- Affiliations of the authors: Institute of Health Policy and Management, Erasmus University Medical Center, Rotterdam, The Netherlands (JA, MB); Nijmegen School of Management, Radboud University Nijmegen, Nijmegen, The Netherlands (HD)
- Correspondence and reprints: Jos Aarts, MSc, Institute of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; e-mail: <j.aarts{at}bmg.eur.nl>
- Received 27 March 2003
- Accepted 24 November 2003
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.
Footnotes
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↵* Eclipsys Corporation has acquired TDS Healthcare Systems Corporation. The TDS7000 hospital information system is now known as the E7000 system. Eclipsys ceased selling the system in 1996 and is now developing its successor, “Sunrise.” The authors emphasize that the system is taken as an example to address implementation issues, none of which are intended to be portrayed as product-specific. We therefore use the term “CPOE system,” or simply “the system.”
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↵† The “medisch stafconvent” is the formal gathering of all tenured medical staff of a Dutch university hospital. The stafconvent advises the hospital board in all matters medical. Some decisions cannot be made without its consent. The board is elected by the membership.
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↵‡ Trabant was a car of East German make that was proverbial for the fully outdated technology of the then communist government.
