Editor—Littlejohns et al identified the reasons for failure to implement a hospital information system in South Africa,1 but they do not emphasise the need for health professionals to be closely involved.
In 1997 we conducted a field test of prototype tools and information flows over six months, with the overall goal of developing a computerised health information system at the three university teaching hospitals (totalling 1500 beds) in Abidjan, Côte d'Ivoire.
In each hospital the system was managed by a team from the administrative department, without a hospital doctor or trained epidemiologist. Before the field test, in five voluntary clinical departments in each hospital, administrative staff underwent intensive training for three weeks. Project presentation workshops with clinicians and nurses were organised in all hospitals, and a ministry of health supervisory team (epidemiologists) was responsible for technical implementation and follow up.
After six months the assessment showed a major failure in implementing the system for three main reasons:
Heavy administrative workload generated by management's inadequate medical and epidemiological education
Limited involvement of medical teams, possibly because of the responsibilities attributed to the administrative departments
Difficulty perceived among practitioners of implementing a health information system that was not judged to be a public health priority, partly because of insufficient knowledge about the goals and functions of a computerised system.2
One of the recommendations of the evaluation was to create specific medical information units with highly specialised epidemiologists in each hospital. Another was to involve healthcare professionals in the project to include exhaustive information about functions and an informational approach to decision making, as well as the advantages and limitations of health information systems.3
Competing interests: None declared.
References
- 1.Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised health information systems: hard lessons still to be learnt. BMJ 2003;326: 860-3. (19 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Osunlaja AA, Olabode JA. Role of an effective hospital information system in a depressed economy. Methods Inf Med 1997;36: 141-3. [PubMed] [Google Scholar]
- 3.Gladwin J, Dixon RA, Wilson TD. Rejection of an innovation: health information management training materials in east Africa. Health Policy Plan 2002;17: 354-61. [DOI] [PubMed] [Google Scholar]