Avdagovska Melita, Stafinski Tania, Ballermann Mark, Menon Devidas, Olson Karin, Paul Pauline
University of Alberta, School of Public Health, Edmonton, AB, Canada.
University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
J Med Internet Res. 2020 May 26;22(5):e17505. doi: 10.2196/17505.
Understanding how health organizations decide on information technology (IT) investments is imperative to ensure successful implementation and adoption. There is a high rate of failure and a tendency to downplay the complexity of implementation progression. Alberta Health Services introduced a patient portal called MyChart. Although MyChart allows patients to view appointments and selected laboratory results and to communicate with their providers, its uptake varies.
The study aimed to examine the institutional decision-making processes that shaped the development and implementation of MyChart.
A historical study was conducted based on the 7-step framework, where one engages in a rigorous archival critical analysis (including internal and external criticism) of documents and analysis of interviews. We reviewed and analyzed 423 primary and secondary sources and interviewed 10 key decision makers.
Supportive leadership, project management, focused scope, appropriate technology and vendor selection, and quick decision making were some of the facilitators that allowed for the growth of proof of concept. The planning and implementation stages did not depend much on the technology itself but on the various actors who influenced the implementation by exerting power. The main barriers were lack of awareness about the technology, proper training, buy-in from diverse system leaders, and centralized government decision making.
Organizational priorities and decision-making tactics influence IT investments, implementation, adoption, and outcomes. Future research could focus on improving the applicability of needs assessments and funding decisions to health care scenarios.
了解卫生组织如何决定信息技术（IT）投资对于确保成功实施和采用至关重要。失败率很高，而且往往忽视实施过程的复杂性。艾伯塔省卫生服务局推出了一个名为MyChart的患者门户网站。虽然MyChart允许患者查看预约信息和部分检查结果，并与他们的医疗服务提供者进行沟通，但其使用情况各不相同。
本研究旨在探讨影响MyChart开发和实施的机构决策过程。
基于七步框架进行了一项历史研究，对文件进行严格的档案批判性分析（包括内部和外部批评）并分析访谈内容。我们查阅并分析了423份主要和次要资料来源，并采访了10位关键决策者。
支持性领导、项目管理、明确的范围、合适的技术和供应商选择以及快速决策是一些促进概念验证发展的因素。规划和实施阶段在很大程度上并不取决于技术本身，而是取决于通过施加权力影响实施的各种行为者。主要障碍包括对技术缺乏认识、缺乏适当培训、不同系统领导者的认同以及政府的集中决策。
组织优先事项和决策策略会影响IT投资、实施、采用和结果。未来的研究可以侧重于提高需求评估和资金决策在医疗保健场景中的适用性。
