Understanding Implementation: a sociotechnical appraisal of the introduction of computerized physician order entry systems in Dutch and American hospitals

"Developing a comprehensive medical information system was a more complex task than putting a man on the moon had been", wrote the eminent medical informatics scholar Morris Collen in 1995. This thesis describes and analyzes the implementation of computerized order entry systems in Dutch and American hospitals. The case studies show how difficult it is to get such systems to work in clinical practice. How such systems can be implemented requires a thorough understanding of medical work practices. The author concludes that formal implementation procedures have limited value and that the successful implementation requires time and a great deal of improvisation. This will allow the prospective user to get acquainted with the system and improve her clinical practice through the opportunities provided by the system. In short, implementing a clinical information system is a thoroughly social process.