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First published June 25, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2629
Journal of the American Medical Informatics Association 2008;15(5):701-704
© 2008 American Medical Informatics Association

A more recent version of this article appeared on September 1, 2008
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Submitted on September 21, 2007
Accepted on May 28, 2008

A near miss: the importance of context in a public health informatics project in a New Zealand case study

Stewart Wells MBChB, MPH1* and Chris Bullen MBChB, MPH1

Affiliation of the authors: 1 Clinical Trials Research Unit, School of Population Health, Faculty of Medical and Health Science, University of Auckland, New Zealand

* To whom correspondence should be addressed.

This paper describes the near failure of an IT system designed to support a government funded, primary care-based hepatitis B screening program in New Zealand. Qualitative methods were used to collect data and construct an explanatory model. Multiple incorrect assumptions were made by system developers about participants, primary care workflows, IT capacity, software vendor user knowledge, and the health IT infrastructure. Political factors delayed system development and it was implemented untested, almost failing. An intensive rescue strategy included system modifications, relaxation of data validity rules, and close engagement with software vendors. The provision of intensive on-site user support using staff with combined clinical and IT skills was found to be a key success factor. This case study demonstrates that consideration of the social, political, technological and healthcare contexts is important for successful implementation of public health informatics projects.






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