Hospital Information Systems (HIS) handle a large number of different types of documents. Exchange and analysis of data from different HIS is facilitated by the use of standardized codes to identify document types.
The case study
Health Waikato Limited (HW) provided hospital services across several sites to a population of 300,000. Under devolved governance arrangements, HW was guided by a politically appointed Board. In 1998, HW purchased a new IS from Shared Medical Systems (SMS), a North American company then the world's second largest health IS supplier. Implementation was beset with problems from the outset and abandoned in 2000, only 18 months after purchase.
Health information systems are required for various functions such as the management of operating theatres, laboratory services, pharmaceuticals, patient records, finance, and so forth. Such components routinely function independently from one another as some are developed 'in house' while others will be purchased from vendors. By contrast, the SMS suite consisted of interoperable modules serving various of the aforementioned purposes. This stated, SMS implementation was not an insubstantial undertaking. It meant complete replacement of existing information systems, training of IS staff and users, and organizational reengineering in terms of how clinical and administrative staff use IS(Pepperell, 2000).
Shortly afterwards, SMS appeared as the favored option as it had been purchased by another New Zealand public hospital, Capital Coast Health (CCH). Several problems with SMS at CCH subsequently emerged. Pre-purchase evaluation of SMS was not as detailed as it could have been. The purchase was driven by the CCH Board who preferred a 'tried and true' version, rather than a newer version preferred by clinical staff. The product delivered to CCH was different from that demonstrated to clinical staff. There were problems launching system components, some of which were ultimately discarded due to difficulties modifying software for New Zealand settings. Furthermore, there was a lack of clinical support for the system as the New Zealand Auditor-General subsequently noted:
Clinical ownership, buy-in and commitment, in their fullest sense, have not been achieved. The system has introduced a level of management control and accountability that was not in place with previous systems. It is fair to say that the primary purpose of some modules is to collect management information as opposed to providing direct assistance to the user in the performance of their job.
The hospital abandoned SMS in 2003.
The HW SMS purchase process
In late July 1997, following a HW Board visit to CCH, and despite the fact that the CCH project had not been established as replicable, a paper written for the HW Board recommended 'that Health Waikato Limited become a partner with Capital Coast Health and SMS in implementation of SMS software solutions. In the absence of a Chief Information Officer, in August 1997, the HW Board engaged a consultant to review its IS strategic plan and SMS preference. This supported HW's decisions, but questioned whether the organization was capable of implementing the SMS project. (Mold, 1998)Instead of being cautioned, the Board recommended ...