Why Health Care Information Systems Succeed or Fail

Richard Heeks, David Mundy, Angel Salazar


Some health care information systems (HCIS) do succeed, but the majority are likely to fail in some way. To explain why this happens, and how failure rates may be reduced, this paper describes the 'ITPOSMO' model of conception-reality gaps. This argues that the greater the change gap between current realities and the design conceptions (i.e. requirements and assumptions) of a new health care information system, the greater the risk of failure.

Three archetypal large design-reality gaps affect the HCIS domain and are associated with an increased risk of failure:

  • Rationality-reality gaps : that arise from the formal, rational way in which many HCIS are conceived, which mismatches the behavioural realities of some health care organisations.
  • Private-public sector gaps : that arise from application in public sector contexts of HCIS developed for the private sector.
  • Country gaps : that arise from application in one country of HCIS developed in a different country.

Some generic conclusions can be drawn about successful approaches to HCIS development. Examples include the need for more reality-oriented techniques and applications, and greater use of participative approaches to HCIS. More specifically, techniques can be identified for each of the seven ITPOSMO dimensions that will help close the gap between conception and reality. This can include the freezing of one or more dimensions of change. Such techniques will help improve the contribution that information systems can make in health care organisations.

Overall, then, this paper will provide readers with an understanding and model of why health care information systems succeed or fail, and with general guidance on how to avoid HCIS failure.

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Educator's guide

Synopsis questions

  1. Why do health care information systems succeed or fail? [all parts]
  2. Do health care information systems mainly succeed or fail? [part A]
  3. What are the archetypal conception-reality gaps? Why do they arise? [part C]
  4. Does imposition of rational information systems help or hinder health care organisations? [part C]
  5. How could you improve the success rate of health care information systems? [part D]

Development questions

  1. Are the seven ITPOSMO dimensions truly 'necessary and sufficient' to explain information systems change in organisations?
  2. Identify a fairly detailed information systems case study, for example from the health care sector. Apply the ITPOSMO/conception-reality model. Does the model help to explain success or failure of this IS?
  3. Can you envisage other archetypal conception-reality gaps that might affect the health care information systems domain or the broader information systems domain?
  4. Identify other explanations for information systems success and failure. How do they compare with the model presented in this paper?
  5. Identify other recommendations for increasing IS success rates or decreasing IS failure rates. How do they compare with the recommendations presented in this paper?
  6. If you are familiar with a health care (or other) organisation, which, if any, of the part D recommendations would be feasible and desirable in that organisation?