Implementation of Health Care Information Systems: Key Factors and the Dynamics of Change

In Greece, the use of information systems in the public health sector is limited (Theodorakioglou and Tsiotras 2000). The Greek National Health Service has initiated reforms towards decentralization of health care services and development of integrated HCIS at a regional level. However, a large number of these plans have not been implemented. This paper addresses an initiative of the Foundation of Research and Technology (FORTH) in Crete. FORTH undertook the development of the information infrastructure for the public health sector of the region. This project is of particular interest because it is the first in Greece that spans all levels of health care across a region. Being a research project, use of the technology is not mandated allowing for the study of spontaneous change. Eight case studies were conducted in primary care clinics in rural areas in Crete using a longitudinal interpretive methodology of multiple interviews, participant observation, and document analysis. Literature from the fields of implementation research, organizational change, and complexity theory are relevant to understand the process of implementation and the organizational change that occurs within these settings. The main points to be discussed in the paper include the experience HCIS implementation in Crete, and the implications for policy and practice for similar implementation initiatives.