Department of Health Administration, University of Montreal, P.O. Box 6128, Station Dowtown, Montreal H3C 3J7, Canada.
Soc Sci Med. 2010 Apr;70(8):1159-65. doi: 10.1016/j.socscimed.2009.11.041. Epub 2010 Feb 4.
Interest in health information exchange (HIE), defined as the use of information technology to support the electronic transfer of clinical information across health care organizations, continues to grow among those pursuing greater patient safety and health care accessibility and efficiency. In this paper, we present the results of a longitudinal multiple-case study of two large-scale HIE implementation projects carried out in real time over 3-year and 2-year periods in Québec, Canada. Data were primarily collected through semi-structured interviews (n=52) with key informants, namely implementation team members and targeted users. These were supplemented with non-participants observation of team meetings and by the analysis of organizational documents. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes: while one project failed, the other was a success. A risk management analysis was performed taking a process view in order to capture the complexity of project implementations as evolving phenomena that are affected by interdependent pre-existing and emergent risks that tend to change over time. The longitudinal case analysis clearly demonstrates that the risk factors were closely intertwined. Systematic ripple effects from one risk factor to another were observed. This risk interdependence evolved dynamically over time, with a snowball effect that rendered a change of path progressively more difficult as time passed. The results of the cross-case analysis demonstrate a direct relationship between the quality of an implementation strategy and project outcomes.
人们对健康信息交换（HIE）的兴趣不断增长，HIE 是指利用信息技术支持医疗保健组织之间的临床信息电子传输。这一兴趣源于人们对提高患者安全性、改善医疗保健的可及性和效率的追求。在本文中，我们展示了对两个在加拿大魁北克省实时开展的、为期 3 年和 2 年的大型 HIE 实施项目进行的纵向多案例研究的结果。数据主要通过对关键信息者（即实施团队成员和目标用户）进行半结构化访谈（n=52）收集。此外，还通过对团队会议的非参与观察和组织文件的分析进行了补充。由于项目情况导致结果截然不同，因此进行跨案例比较尤为相关：一个项目失败，而另一个项目则取得了成功。为了捕捉项目实施的复杂性，我们从过程角度进行了风险管理分析，因为项目实施是一个不断演变的现象，受到相互依存的现有和新兴风险的影响，这些风险往往会随时间而变化。纵向案例分析清楚地表明，风险因素密切相关。从一个风险因素到另一个风险因素的系统性连锁反应被观察到。这种风险的相互依存关系随着时间的推移而动态演变，随着时间的推移，产生了滚雪球效应，使得改变路径变得越来越困难。跨案例分析的结果表明，实施策略的质量与项目结果之间存在直接关系。
