Developing a decision-making framework for the adoption of health information systems

Context - Across today’s patient-centric healthcare models, Health Information System (HIS) have become integral to deliver healthcare benefits across society. For example, through HIS adoption, healthcare stakeholders can benefit from added efficiencies associated with technology-enabled healthcare services and often promote the opportunities for improved ‘patient-centric care’. Problem - Decision-making plays a pivotal role in the adoption of HIS. However, HIS adoptions are fraught with challenges and the growing recognition that issues often stem from a lack of guidance in HIS adoption decision-making. Furthermore, there is little documented evidence of the particular HIS decision-making frameworks employed in hospitals, resulting in unsuccessful HIS adoption. The adoption of HIS is considered one of the most important decisions in hospitals; yet, hospital decision-makers, specifically the Chief Clinical Information Officers (CCIO) and patients' roles in decision-making processes for adopting HIS remain unclear. Objective - This research aims to identify key adoption decision-making factors associated with HIS from the hospital stakeholder’s perspective. Based on the stakeholder’s feedback, this research further explores the role of the CCIO and patients and the key challenges they faced during HIS’s adoption decision-making. Methods - To address the objective, a mixed-method approach was taken. A systematic literature review looked into different HIS adoption factors, adoption theories, and decision-making theories to address the documented evidence of specific HIS adoption decision-making factors. Building on the literature review, multiple case study approaches were conducted to understand the phenomenon of HIS's adoption decision-making from different healthcare stakeholders' perspectives. For interviews, Interpretative Phenomenological Analysis (IPA) qualitative methodology was used by the researcher. Data analysis was undertaken using thematic analysis, coding data according to key themes and subcategories. Each phase yielded an augmented set of recommendations. The derived themes and recommendations were evaluated by conducting inter-rater reliability tests. A systematic literature review was then done on the patient’s technology adoption decision-making to find how patients can be involved in the decision-making process. In the end, patients were interviewed to identify their perspective on the decision-making phenomenon and integrated it into the final framework. Results – From the literature, the DECIDE model was identified as a theoretical foundation for decision-making within a hospital context and extended further by considering the influence of patient involvement in HIS adoption decision-making. One of the factors (patient centric) appeared to be overlooked in the literature and the hospital. To see how patient-centric can be achieved, an additional literature review and interviews were carried out. The research drew from the literature and interviews and learned about hospital stakeholders' needs and challenges during HIS adoption decision-making. Also, the result identified that there was no standardised approach for the HIS adoption decision-making used in the hospitals. Thus, this research proposes a new decision-making framework for adopting HIS (DMFA-HIS), offering hospitals guidance on adopting HIS. The DMFA-HIS integrates two different aspects of decision-making and adoption, making it more robust, covering multi-aspects for the hospitals. It is anticipated that the DMFA-HIS will be generalisable across all national hospitals and healthcare organisations. Conclusions - This research can support researchers and hospital management identify and manage adoption decision-making factors and helping hospitals make better decisions for HIS adoption. The decision on adopting HIS is a complex process, and consequently, there are many perspectives to be considered. This research contributes to the literature about adoption decision-making by summarising the key research findings on the state-of-the-art developments on decision-making on HIS adoption. It also provides vital recommendations towards the key decision-making factors that can help in adopting HIS and making it patient centric at the same time. The DECIDE model has been developed explicitly to aid healthcare managers. However, a single theory is insufficient to explain a complex interdependent phenomenon, such as patient involvement in the decision-making process. Given shortcomings recognised in this research, this thesis has extended the DECIDE model to the DMFA-HIS, considering decision-making for HIS adoption in hospitals and explicitly focusing on patients' impact on the HIS adoption decision-making process.