Commentary: Electronic Patient Records: Confronting the Implementation Challenge

• Author: Kjeld Møller Pedersen
• DOI: http://doi.org/10.1111/puar.12844
• Published date: 01 November 2017
• Date: 01 November 2017

Electronic Patient Records: Confronting the Implementation Challenge 861

Public Administration Review,

Vol. 77, Iss. 6, pp. 861–862. © 2017 by

The American Society for Public Administration.

DOI: 10.1111/puar.12844.

Electronic Patient Records:

Confronting the Implementation Challenge

Kjeld Møller Pedersen is professor

of health economics and policy at the

University of Southern Denmark. He

introduced electronic patient record

systems while chief executive officer of a

county health service and while executive

vice president of LEGO, where he also

downsized in-house software development.

E-mail: kmp@sam.sdu.dk

Commentary

T he knowing/doing gap refers to the gap

between what people in organizations know

and what they actually implement. This

also holds for the implementation of systems. We

actually know quite a bit about implementation of

information and communication technology (ICT)

systems—but do we follow this knowledge? Morten

Balle Hansen and Iben Nørup ’ s article, “Leading

the Implementation of ICT Innovations,” makes a

valuable contribution to the implementation literature

by documenting the importance of leadership and

assessing the impact of various leadership styles. One

can only hope that Hansen and Nørup ’ s findings will

influence future implementation projects.

What is common to Massachusetts General Hospital,

Cambridge University Hospital, Copenhagen

University Hospital, and numerous other hospitals?

They have all experienced massive problems with the

implementation of electronic patient record (EPR)

systems—problems that led to lower patient intake

for several months and subsequent financial losses,

problems with transferring data such as discharge

letters to national databases and other health care

providers, and dissatisfaction among professionals—

doctors, for example, in particular. Some Danes

have attributed such problems to the U.S. origin

of the EPR system with an embedded American

understanding of hospital care and organization.

However, in view of geographically widespread

implementation problems with this and other systems,

other factors offer what are likely more relevant

explanations. Well-functioning EPR systems are the

nerve centers of modern hospitals, and investments

run into billions of euros.

Hansen and Nørup assess the impact of variations

in leadership style on the efficacy of innovative ICT

implementation. The authors ’ quasi-experimental

approach with two groups—the units that followed

the centrally recommended implementation strategy

and units that followed a local strategy, the trial

group—leads to persuasive findings.

The authors ’ four leadership-related hypotheses each

found support in positive and significant statistical

relationships. Initially, supportive and participative

leadership proved to be very strong covariates,

while directive leadership and locally adopted

implementation found only moderately strong

covariation.

Of course, the importance of leadership is hardly a

revolutionary finding. The IT implementation world

has long acknowledged the importance of both top-

down leadership and participative decision making.

The real piece of news is that Hansen and Nørup have

provided serious and specific documentation by using

their statistically constructed leadership indices.

To build on their work, further research should

seek deeper insight into which leadership traits and

practices are important and hence should be present

for successful implementation—or at least as a

necessary condition for successful implementation.

For instance, does it matter that the chief executive

officer is (also) knowledgeable about IT (which was

the situation in the case hospital)? The first of the

authors ’ hypotheses proposed the importance of initial

widespread support for a new EPR system, but we

would hope to learn how such support is built and

how to “sell” it. As the authors found a significant

decline after implementation was observed, we would

like to determine whether there is a risk of overselling

the benefits to create enthusiasm while neglecting

the downside—for instance, the need to change

individual work routines and work flow. In their study

and in other cases in my experience, doctors—who

often are outspoken opinion leaders—quickly showed

declining enthusiasm, which can be detrimental

to the implementation climate. A recent EPR

implementation at Copenhagen University Hospital

quickly led to skepticism among doctors—even

calling for a halt of the process—because they found

out that under the new system, they were carrying out

tasks previously handled by medical secretaries. This,

Kjeld Møller Pedersen

University of Southern Denmark , Denmark