Yusof MM et al. 2008 "An evaluation framework for health information systems: human, organization and technology-fit factors (HOT-fit)."

Reference
Yusof MM, Kuljis J, Papazafeiropoulou A, et al. An evaluation framework for health information systems: human, organization and technology-fit factors (HOT-fit). Int J Med Inf 2008;77(6):386-398.
Abstract
"Background and purpose: The realization of Health Information Systems (HIS) requires rigorous evaluation that addresses technology, human and organization issues. our review indicates that current evaluation methods evaluate different aspects of HIS and they can be improved upon. A new evaluation framework, human, organization and technology-fit (HOT-fit) was developed after having conducted a critical appraisal of the findings of existing HIS evaluation studies. HOT-fit builds on previous models of IS evaluation-in particular, the IS Success Model and the IT-Organization Fit Model. This paper introduces the new framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit. Methods: Literature review on HIS and IS evaluation studies and pilot testing of developed framework. The framework was used to evaluate a Fundus Imaging System (FIS) of a primary care organization in the UK. The case study was conducted through observation, interview and document analysis. Results: The main findings show that having the right user attitude and skills base together with good leadership, IT-friendly environment and good communication can have positive influence on the system adoption. Conclusions: Comprehensive, specific evaluation factors, dimensions and measures in the new framework (HOT-fit) are applicable in HIS evaluation. The use of such a framework is argued to be useful not only for comprehensive evaluation of the particular FIS system under investigation, but potentially also for any Health Information System in general."
Objective
"To show how we derived a framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit."
Type Clinic
Primary care and specialty care
Type Specific
Specialty: radiology
Size
Small, medium and large
Other Information
The case study takes place in "clinical settings of a primary care organization (PCO) and two of its collaborating specialist hospitals, all members of the UK National Health Service (NHS)." The primary care practice has 6,000 patients, mostly elderly.
Type of Health IT
Digital imaging
Type of Health IT Functions
The health IT in the case study is "a digital Fundus Imaging System (FIS) for diabetic retinopathy... FIS consists of a fundus camera and digital imaging software that is used to capture the eye images of patients with diabetes. FIS has functions for image capture, image manipulation, patient data management, image transfer, viewing, and temporary storage. For each captured eye image, the system assembles the image, patient data, and timer data into a data file. These data files are transferred to the [EHR] by attaching each image to associated patient."
Context or other IT in place
"A number of [health IT applications] were already in place, including telemedicine and [an electronic health record (EHR) system]."
Workflow-Related Findings
"The barrier to using the system can be seen from the lack of familiarity of the user in using basic file organization functions, such as copying files, and in performing time consuming and tedious tasks such as deleting and transferring files. This process resulted in user dissatisfaction because in her view, it is taking a lot of her limited time."
"The use of FIS has increased the [general practitioner] GP's work volume. She has to spend additional hours in the retinal clinic capturing the eye images, as well as storing and transferring them to the patient notes. In addition, she has to spend a few hours per month for regular training sessions."
"The ease of use of the Fundus Imaging System (FIS) can be seen immediately as a user friendly, simple to use interface and straightforward data entry mode."
"The frequent need to delete and transfer files from a small size memory card (attached to the camera) to a hard drive when it gets full was seen as tedious and time consuming. The user, Dr. ABC said 'it is a pain to keep on deleting the [images on the] memory card when it is full and it gets full quickly because it has small storage capacity.' She had to take the card out and upload the patient's images to the [personal computer] PC and linked them with the patient records and saved them in a specific folder."
Study Design
Only postintervention (no control group)
Study Participants
"Clinicians, staff and patients who were associated with [the imaging system], both from the primary care organization and from the two specialist hospitals [were] involved in the study."