Discussion of Article
The main issue discussed in this paper is the apparent high rate of failures of information systems initiatives in health care organisations in the private sector and the public sector. The writers contend that while some Health Care Information Systems (HCIS) do succeed, the majority are likely to fail in some way because of conception – reality gaps as described by the ITPOSMO model. The paper attempts to provide an understanding and model of why HCIS succeed or fail, and with general guidance on how to avoid HCIS failure.
The paper argues that the main reason which determines the failure or success is the extent of change between ‘where we are now’ and ‘where the HCIS wants to get us’ or dimension of change Conception—Reality Gaps.
To understand this, the paper examines two case studies to analyze gaps that existed between the system’s design conceptions and contextual realities along seven dimensions of Information, Technology, Processes, Objectives and values, Staffing and skills, Management and structures and Other resources such as money and time, described as the ITPOSMO model of conception—reality gaps. The case studies show that where the design of the system either matched the existing realities, or required very little change, the system succeeded in that there was greater acceptance and usage of the system. The opposite occurred where the gap between conception and reality was too great with the result being the abandoning of the system.
Furthermore, the paper then highlights three archetypal conception – reality gaps that can make HCIS failure more likely: •when health care information systems derived from hard rational models of organisation meet different behavioural reality; •when HCIS derived from the private sector are transferred to public sector health care organisations; and •when CIS...