Planned implementation of an integrated Cardiovascular Information System in an Acute Hospital

105 Pages·2017·2.32 MB·English

by  Paul G. Nolan

Royal College of Surgeons in Ireland
e-publications@RCSI
Masters theses/dissertations - taught courses Theses and Dissertations
1-1-2015
Planned implementation of an integrated
Cardiovascular Information System in an Acute
Hospital Group
Paul G. Nolan
Royal College of Surgeons in Ireland
Citation
Nolan PG. Planned implementation of an integrated Cardiovascular Information System in an Acute Hospital Group [Masters
dissertation]. Dublin: Royal College of Surgeons in Ireland; 2015.
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Planned implementation of an
integrated Cardiovascular Information
System in an Acute Hospital Group

Paul G. Nolan

A Dissertation submitted in part fulfilment of the
degree of
MSc Leadership,
Institute of Leadership, Royal College of Surgeons
in Ireland

2015
Planned implementation of an
integrated Cardiovascular Information
System in an Acute Hospital Group

MSc in Leadership 2015

Student ID: 13120816
Submission Date: 13th May 2015
Word Count: 16493
Facilitator: Sibeal Carolan
Acknowledgements

I would firstly like to thank the Health Service Executive West for their
sponsorship without which I could not have undertaken this MSc

I have huge appreciation for all the staff in the Royal College of
Surgeons, Institute of Leadership who have helped guide me on my two
year journey but special thanks must go to Steve Pitman and our ALS
facilitator Sibeal Carolan

To my fellow classmates, I learnt an awful lot from you, not only during
lectures but also during discussions over coffee. To my colleagues in
our action learning set, many thanks for your input, guidance and
energy, I can only hope that you got as much from me as I got from
you.

To my work colleagues in the department, many thanks for being so
supportive over the two years and filling in gaps to allow me fully
participate in the course. To those who have contributed to the working
group, again my appreciation for your time.

To my Dad, many thanks for the accommodation, breakfasts, packed
lunches, your excellent proof reading and support.

To my wife Leonie, thanks for all your support, putting up with the
absences, the bad moods and making me smile when I needed to.

I
Abstract

Computer based patient records have been highlighted as a
requirement in modern healthcare. Evidence around their contribution
to quality of care is mixed and is more reliant on how well they are
implemented, with there being a bedding in period of up to one year
before seeing benefits. Successful implementation leads to efficiencies,
cost savings and a return on the significant financial outlay. The need
for funding can be a major barrier, as are changes in work practices and
people issues such as resistance. Sites with great implementation have
high levels of clinician involvement, leadership with vision, resilience,
flexibility and collaboration. This project outlines the plan to deliver a
CVIS which will integrate across a hospital group. It has identified
triggers for change and forces that might prevent it, has developed a
communication plan based on a stakeholder analysis. It has created a
collaborative working group, involving key stakeholders who have
agreed the key priorities and essential features of the system.
Important milestones are highlighted, such as addressing the funding,
putting governance in place, selecting the correct vendor, having
sufficient hardware, software and training in place. The project will be
evaluated throughout its life cycle using a novel WHO-HOT-Fit
framework. The project is an academically robust, strategic plan to
implement a CVIS which will require leadership that is collaborative,
honest and seeks out, and identifies people with talent and tacit
knowledge who can contribute to the process.

II
Table of Contents

Acknowledgements ................................................................................. I
Abstract .................................................................................................. II
List of figures .......................................................................................... V
List of Abbreviations .............................................................................. VI
Chapter 1 Introduction .................................................................... 1
1.1 Introduction ............................................................................................... 1
1.2 Aims and Objectives ................................................................................ 2
1.3 Organisational Context and Project Rationale....................................... 3
1.4 Potential threats to implementation ........................................................ 6
1.5 Method of Evaluation ............................................................................... 8
Chapter 2 Literature Review ............................................................. 10
2.1 Introduction ............................................................................................. 10
2.2 Search strategy ...................................................................................... 12
2.3 Impact of Electronic Health Records on Quality of Care .................... 13
2.4 Other benefits of Electronic Health Records........................................ 17
2.5 Keys to successful implementation of an Electronic Health Record . 18
2.6 Barriers to Electronic Health Record implementation ......................... 22
2.7 Summary ................................................................................................. 26
Chapter 3 Methods and Methodology ........................................... 28
3.1 Introduction ............................................................................................. 28
3.2 Review of Organisational Development approaches and rationale for
chosen model ..................................................................................................... 28
3.3 Approach to the change using the HSE Change Model ..................... 33
3.3.1 Initiation ........................................................................................... 33
3.3.2 Planning .......................................................................................... 36
3.3.3 Implementation ............................................................................... 41
3.3.4 Mainstreaming ................................................................................ 46
3.4 Summary ................................................................................................. 47
Chapter 4 Evaluation .................................................................... 48
4.1 Introduction ............................................................................................. 48
4.2 Evaluation in Health Information System projects ............................... 48
III
4.3 Evaluation Frameworks for Health Information Systems .................... 50
4.4 Evaluation indicators to be used ........................................................... 54
4.5 Summary ................................................................................................. 59
Chapter 5 Discussion and Conclusions ........................................ 60
5.1 Introduction ............................................................................................. 60
5.2 Strengths and weaknesses of the implementation plan ..................... 60
5.3 Impact of the planned change project .................................................. 66
5.3.1 Impact on the organisation ............................................................ 66
5.3.2 Impact on Stakeholders ................................................................. 67
5.3.3 Impact on patients .......................................................................... 68
5.3.4 Impact on Theory and Practice ..................................................... 69
5.3.5 Personal impact .............................................................................. 70
5.4 Recommendations and Conclusions .................................................... 72
6 References .................................................................................... 74
7. Appendices .................................................................................... 87

IV
List of figures

Figure 1.1 Map of Hospital Groups, established as a transition to
independent hospital trusts 4

Figure 3.1 Kotter’s 8 step change model 29

Figure 3.2 The HSE Change Model 32

Figure 4.1 The Updated DeLone and McLean Model of Information
System Success 51

Figure 4.2 The Human-Organisational-Technology Fit (HOT-Fit)
evaluation framework 52

Figure 4.3 The proposed WHO-HOT-Fit Evaluation Framework 54

V
List of Abbreviations

CEO Chief Executive Officer
CIO Chief Information Officer
CVIS Cardiovascular Information System
EHR Electronic Health Record
HSE Health Service Executive
IT Information Technology
NHS National Health Service
NIMIS National Image Management Information System
PACS Picture Archiving and Communication System
PESTLE Political, Economic, Social, Technological, Legal,
Environmental
pPCI Primary Percutaneous Coronary Intervention
SMART Specific, Measureable, Achievable, Realistic, Time-bound
SWOT Strengths, Weaknesses, Opportunities, Threats

VI