The implementation of electronic health records: A case study of bush computing the Ngaanyatjarra Lands

ObjectiveThe adoption of Information and Communication Technologies (ICT) in the health sector has often lagged behind adoption in other sectors as there are a number of systemic inhibitors that make the adoption of ICT far more complex. This paper aims to explore and investigate the drivers, facilitators and barriers to electronic health records adoption in the health sector and provide some guidance on how to improve the prospect of successful adoption.MethodsA case study of the successful development of electronic health records in remote Western Australia is used to identify and highlight the drivers, facilitators and barriers to electronic records adoption. A content analysis was undertaken on the in-depth interviews with participants in the region to identify the key issues and challenges and how they were overcome.ResultsThe geographically isolated nature of the region had a number of benefits since it meant the electronic health records project was a manageable size and cost, the focus could be on developing a workable system rather than a ‘perfect solution’, decisions could be made autonomously without considering integration issues with other regions, the transient nature of the patients was a key driver, the patient centred approach elevated the importance of overcoming problems, and the system champions were determined to make the system a workable success.ConclusionsComplex systemic problems often derail ICT projects. The case study of an isolated region provides a number of lessons and insights to improve electronic records adoption projects. The limited resources and limited choices faced by the region lead to the development of a number of key approaches that revolved around aiming for a workable system rather than a high-end flawless solution. This ethos pervaded the electronic health records project and was underpinned by a patient centred approach and a strong desire to improve the service given to patients.

► Digital records adoption is a major challenge in Australia.
► We identify from the literature a number of systemic, organisational, cost related and privacy issues that serve as barriers to adoption.
► A case study is presented of a remote region's successful attempt at developing a digital patient records system.
► The self-contained nature of the records implementation, the system champions, the “can do” mentality, the patient focus, and the emphasis on a workable system were all reasons why the system succeeded.