Desafíos de los programas gubernamentales para la implementación a gran escala de sistemas de información en salud
DOI:
https://doi.org/10.5433/1981-8920.2022v27n4p456Palabras clave:
Sistema de información en salud, Tecnología de la información en salud, Implementación nacional, Administración pública, GobiernoResumen
Objetivo: La implementación nacional de sistemas de información en salud se ha llevado a cabo a nivel internacional y se considera un proceso complejo permeado de desafíos. Este estudio tiene como objetivo analizar los factores que han afectado los resultados de iniciativas gubernamentales de esta naturaleza.
Metodología: Metodológicamente, se realizó una revisión bibliográfica utilizando el Proceso de Desarrollo del Conocimiento - Constructivista (Proknow-C). Los artículos identificados a través de este proceso fueron sometidos a un análisis de contenido utilizando procedimientos de codificación y categorización.
Resultados: Los resultados revelan un conjunto de 19 categorías que abarcan aspectos sociotécnicos que afectaron la implementación de sistemas de información en salud a nivel internacional. Estos aspectos están relacionados con el contexto nacional más amplio en el que se introdujo el sistema (nivel macro), las instituciones donde se implementaron los sistemas y sus peculiaridades locales (nivel meso), y los atributos de individuos, tecnología y procesos de salud involucrados (nivel micro).
Conclusiones: Varios aspectos intra e internivel (macro, meso y micro) están interconectados, dando forma a los procesos de implementación del sistema y sus resultados. A pesar de cubrir estudios relacionados con la implementación de sistemas de información en salud en diferentes países, cada uno con diferentes niveles de desarrollo tecnológico, los desafíos registrados, los factores críticos de éxito y las mejores prácticas informadas muestran similitudes.
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AANESTAD, M.; JOLLIFFE, B.; MUKHERJEE, A.; SAHAY, S. Infrastructuring work: Building a state-wide hospital information infrastructure in India. Information Systems Research, [S. l.], v. 25, n. 4, p. 834-845, Dec. 2014. DOI: https://doi.org/10.1287/isre.2014.0557
AANESTAD, M.; JENSEN, T. B. Building nation-wide information infrastructures in healthcare through modular implementation strategies. The Journal of Strategic Information Systems. Journal of Strategic Information Systems, [S. l.], v. 20, n. 2, p. 161-176, 2011. DOI: https://doi.org/10.1016/j.jsis.2011.03.006
ANDARGOLI, E.; SCHEEPERS, H.; RAJENDRAN, D.; SOHAL, A. Health Information Systems Evaluation Frameworks: a systematic review. International Journal Of Medical Informatics, [S. l.], v. 97, p. 195-209, Oct. 2017. DOI: https://doi.org/10.1016/j.ijmedinf.2016.10.008
BOX, T. L.; MCDONELL, M.; HELFRICH, C. D.; JESSE, R. L.; FIHN, S. D.; RUMSFELD, J. S. Strategies from a nationwide health information technology implementation: the VA CART story. Journal of general internal medicine, [S. l.], v. 25, Supl. 1, p. 72-76, Jan. 2010. DOI: https://doi.org/10.1007/s11606-009-1130-6
COIERA, E. Building a national health IT system from the middle out. Journal of the American Medical Informatics Association, [S. l.], v. 16, n. 3, p. 271-273, 2009. DOI: https://doi.org/10.1197/jamia.M3183
CRESSWELL, K.; SHEIKH, A.; FRANKLIN, B. D.; KRASUSKA, M.; NGUYEN, H. T.; HINDER, S.; LANE, W.; MOZAFFAR, H.; MASON, K.; EASON, S.; POTTS, H. W. W.; WILLIAMS, R. Theoretical and methodological considerations in evaluating large-scale health information technology change programmes. BMC Health Services Research, [S. l.], v. 20, n. 477, 2020. DOI: https://doi.org/10.1186/s12913-020-05355-7
CRESSWELL, K. M.; BATES, D. W.; SHEIKH, A. Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, [S. l.], v. 20, n. e1, p. e9-e13, 2013. DOI: https://doi.org/10.1136/amiajnl-2013-001684
CRESSWELL, K. M.; WORTH, A.; SHEIKH, A. Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation. Health Informatics Journal, [S. l.], v. 18, n. 4, p. 251-270, 2012. DOI: https://doi.org/10.1177/1460458212445399
CRESSWELL, K. M.; WORTH, A.; SHEIKH, A. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC: Medical Informatics And Decision Making, [S. l.], v. 10, n. 67, 2010. DOI: https://doi.org/10.1186/1472-6947-10-67
CRESSWELL, K.; MORRISON, Z.; CROWE, S.; ROBERTSON, A.; SHEIKH, A. Anything but engaged: user involvement in the context of a national electronic health record implementation. Informatics in Primary Care, [S. l.], v. 19, n. 4, p. 191-206, 2011. DOI: https://doi.org/10.14236/jhi.v19i4.814
CURRIE, W. L. Institutional isomorphism and change: the national programme for IT–10 years on. Journal of Information Technology, [S. l.], v. 27, n. 3, p. 236-248, 2012. DOI: https://doi.org/10.1057/jit.2012.18
CURRIE, W. L. Translating health IT policy into practice in the UK NHS. Scandinavian Journal of Information Systems, [S. l.], v. 26, n. 2, p. 3-26, 2014.
CURRIE, W. L.; FINNEGAN, D. J. The policy-practice nexus of electronic health records adoption in the UK NHS: an institutional analysis. Journal of enterprise information management, [S. l.], v. 24, n. 2, p. 146-170, 2011. DOI: https://doi.org/10.1108/17410391111106284
DERIEL, E.; PUTTKAMMER, N.; HYPPOLITE, N.; DIALLO, J.; WAGNER, S.; HONORÉ, J. G.; BALAN, J. G.; CELESTIN, N.; VALLÈS, J. S.; DUVAL, N.; THIMOTHÉ, G.; BONCY, J.; COQ, N. R. L.; BARNHART, S. Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti. Health Policy and Planning, [S. l.], v. 33, n. 2, p. 237-246, 2018. DOI: https://doi.org/10.1093/heapol/czx171
DEUTSCH, E.; DUFTSCHMID, G.; DORDA, W. Critical areas of national electronic health record programs - Is our focus correct?. International Journal of Medical Informatics, [S. l.], v. 79, n. 3, p. 211-222, 2010. DOI: https://doi.org/10.1016/j.ijmedinf.2009.12.002
ENSSLIN, L.; MUSSI, C. C.; CHAVES, L. C.; DEMETRIO, S. N. It outsourcing management: The state of the art recognition by a constructivist research process and bibliometrics. Journal of Information Systems and Technology Management, [S. l.], v. 12, n. 2, p. 371-392, May/Aug. 2015.
FRAGIDIS, L. L.; CHATZOGLOU, P. D. Implementation of a nationwide electronic health record (EHR) the international experience in 13 countries. International Journal of Health Care Quality Assurance, [S. l.], v. 31, n. 2, p. 116-130, 2018. DOI: https://doi.org/10.1108/IJHCQA-09-2016-0136
GREENHALGH, T.; MORRIS, L.; WYATT, J. C.; THOMAS, G.; GUNNING, K. Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland. International Journal of Medical Informatics, [S. l.], v. 82, n. 5, May. 2013. DOI: https://doi.org/10.1016/j.ijmedinf.2013.01.002
GREENHALGH, T.; STRAMER, K.; BRATAN, T.; BYRNE, E.; MOHAMMAD, Y.; RUSSELL, J. Introduction of shared electronic records: multi-site case study using diffusion of innovation theory. BMJ, [S. l.], v. 337, Oct. 2008. DOI: https://doi.org/10.1136/bmj.a1786
GREENHALGH, T.; STRAMER, K.; BRATAN, T.; BYRNE, E.; RUSSELL, J.; POTTS, H.W. Adoption and nonadoption of a shared electronic summary record in England: a mixed-method case study. BMJ, v. 340, p. c3111, 2010. DOI: https://doi.org/10.1136/bmj.c3111
GUALDANI, F. A.; MARCHI, K. R. da C.; ALVES, F. H.; BOTEGA, L. C. Critérios de qualidade de dados em saúde: uma análise quantitativa. Informação & Informação, Londrina, v. 27, n. 2, p. 466-490, 2022.
KATEHAKIS, D. G.; HALKIOTIS, S.; KOUROUBALI, A. Materialization of Regional Health Information Networks in Greece: Electronic Health Record Barriers & Enablers. Journal of Healthcare Engineering, [S. l.], v. 2, n. 3, p. 389-403, 2011. DOI: https://doi.org/10.1260/2040-2295.2.3.389
KLECUN, E.; ZHOU, Y.; KANKANHALLI, A.; WEE, Y. H.; HIBBERD, R. The dynamics of institutional pressures and stakeholder behavior in national electronic health record implementations: A tale of two countries. Journal of Information Technology, [S. l.], v. 34, n. 4, p. 292-332, Mar. 2019. DOI: https://doi.org/10.1177/0268396218822478
LIPPEVELD, T.; SAUERBORN, R.; BODART, C. (ed.). Design and Implementation of Health Information Systems. Geneva: World Health Organization, 2000.
LUDWICK, D. A.; DOUCETTE, J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics, [S. l.], v. 78, n. 1, p. 22-31, 2009. DOI: https://doi.org/10.1016/j.ijmedinf.2008.06.005
LUZ, R.; MUSSI, C. C.; DUTRA, A.; CHAVES, L. C. Implementation of large-scale health information systems. Revista de Gestão, São Paulo, v. 28, n. 2, p. 106-132, 2021. DOI: https://doi.org/10.1108/REGE-06-2019-0064
MCGINN, C. A.; GAGNON, M.-P.; SHAW, N.; SICOTTE, C.; MATHIEU, L.; LEDUC, Y.; GRENIER, S.; DUPLANTIE, J.; ABDELJELIL, A. B. LÉGARÉ, F. Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study. BMC: Medical Informatics and Decision Making, [S. l.], v. 12, n. 105, Sept. 2012. DOI: https://doi.org/10.1186/1472-6947-12-105
MORRISON, Z.; ROBERTSON, A.; CRESSWELL, K.; CROWE, S.; SHEIKH, A. Understanding contrasting approaches to nationwide implementations of electronic health record systems: England, the USA and Australia. Journal of Healthcare Engineering, [S. l.], v. 2, n. 1, p. 25-41, 2011. DOI: https://doi.org/10.1260/2040-2295.2.1.25
LUZ, R.; DUTRA, A.; LACERDA, R.; MUSSI, C. C.; CHAVES, L. C. Large-scale health informationsystems: selection and analysis of a bibliographic portfolio. In: INTERNATIONAL CONFERENCE ON INFORMATION RESOURCES MANAGEMENT (CONF-IRM), 2019, Auckland. Proceedings […]. Auckland: CONF-IRM, 2019.
MUSSI, C. C.; PEREIRA, C. D. do V.; LACERDA, R. T. de O.; SANTOS, E. M. dos. Pre-Implementation evaluation of a nationwide information system for university hospitals: lessons learned from a study in Brazil. Behaviour & Information Techp.ology, [S. l.], v. 37, n. 3, p. 217-231, 2018. DOI: https://doi.org/10.1080/0144929X.2018.1430850
PAYNE, T. H.; DETMER, D. E.; WYATT, J. C.; BUCHAN, I. E. National-scale clinical information exchange in the United Kingdom: lessons for the United States. Journal of the American Medical Informatics Association, [S. l.], v. 18, n. 1, p. 91-98, Jan./Feb. 2011. DOI: https://doi.org/10.1136/jamia.2010.005611
PETTIGREW, A. M. Context and action in the transformation of the firm. Journal of Management Studies, [S. l.], v. 24, n. 6, p. 649-670, Nov. 1987. DOI: https://doi.org/10.1111/j.1467-6486.1987.tb00467.x
PEUTE, L. W.; AARTS, J.; BAKKER, P. J.; JASPERS, M. W. Anatomy of a failure: a sociotechnical evaluation of a laboratory physician order entry system implementation. International journal of medical informatics, v.79, n. 4, p. e58-e70, 2010. DOI: https://doi.org/10.1016/j.ijmedinf.2009.06.008
RIPPEN, H.E.; PAN, E.C.; RUSSELL, C.; BYRNE, C.; SWIFT, E. Organizational framework for health information technology. International Journal of Medical Informatics, v. 82, n. 4, p. e1-e13, 2013. DOI: https://doi.org/10.1016/j.ijmedinf.2012.01.012
ROBERTSON, A.; CRESSWELL, K.; TAKIAN, A.; PETRAKAKI, D.; CROWE, S.; CORNFORD, T.; BARBER, N.; AVERY, A.; FERNANDO, B.; JACKLIN, A.; PRESCOTT, R.; KLECUN, E.; PATON, J.; LICHTNER, V.; QUINN, C.; ALI, M.; MORRISON, Z.; JANI, Y.; WARING, J.; MARSDEN, K.; SHEIKH, A. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ, [S. l.], v. 341, Sept. 2010. DOI: https://doi.org/10.1136/bmj.c4564
ROSS, J.; STEVENSON, F.; LAU, R.; MURRAY, E. Factors that influence the implementation of ehealth: a systematic review of systematic reviews (an update). Implementation Science, v.11, n. 1, p. 146-158, 2016. DOI: https://doi.org/10.1186/s13012-016-0510-7
ROZENBLUM, R.; JANG, Y.; ZIMLICHMAN, E.; SALZBERG, C.; TAMBLYN, M.; BUCKERIDGE, D.; FORSTER, A.; BATES, D. W.; TAMBLYN, R. A qualitative study of Canada’s experience with the implementation of electronic health information technology. CMAJ, [S. l.], v. 183, n. 5, Mar. 2011. DOI: https://doi.org/10.1503/cmaj.100856
SHEIKH, A.; CORNFORD, T.; BARBER, N.; AVERY, A.; TAKIAN, A.; LICHTNER, V.; PETRAKAKI, D.; CROWE, S.; MARSDEN, K.; ROBERTSON, A.; MORRISON, Z.; KLECUN, E.; PRESCOTT, R.; QUINN, C.; JANI, Y.; FICOCIELLO, M.; VOUTSINA, K.; PATON, J.; FERNANDO, B.; JACKLIN, A.; CRESSWELL, K. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ, [S. l.], v. 343, p. d6054, 2011. DOI: https://doi.org/10.1136/bmj.d6054
SICOTTE, C.; PARÉ, G. Success in health information exchange projects: Solving the implementation puzzle. Social Science & Medicine, [S. l.], v. 70, n. 8, p. 1159-1165, 2010. DOI: https://doi.org/10.1016/j.socscimed.2009.11.041
SLIGO, J.; GAULD, R.; ROBERTS, V.; VILLA, L. A literature review for large-scale health information system project planning, implementation and evaluation. International journal of medical informatics, [S. l.], v. 97, p. 86-97, Jan. 2017. DOI: https://doi.org/10.1016/j.ijmedinf.2016.09.007
STRAUSS, A.; CORBIN, J. M. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage, 1998.
TSIKNAKIS, M.; KOUROUBALI, A. Organizational factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework. International Journal of Medical Informatics, [S. l.], v. 78, n. 1, p. 39-52, Jan. 2009. DOI: https://doi.org/10.1016/j.ijmedinf.2008.07.001
VEDLŪGA, T.; MIKULSKIENĖ, B. Stakeholder driven indicators for eHealth performance management. Evaluation and Program Planning, [S. l.], v. 63, p. 82-92, Aug. 2017. DOI: https://doi.org/10.1016/j.evalprogplan.2017.03.001
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Derechos de autor 2023 Clarissa Carneiro Mussi, Ricardo Luz, Dioni da Rosa Damázio, Ernani Marques dos Santos, Violeta Sun
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