Electronic clinical decision support (eCDS) in primary health care: a multiple case study of three New Zealand PHOs : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Information Systems at Massey University, Palmerston North, New Zealand

Abstract

Health care providers internationally are facing challenges surrounding the delivery of high quality, cost effective services. The use of integrated electronic information systems is seen by many people working in the health sector as a way to address some of the associated issues. In New Zealand the primary health care sector has been restructured to follow a population based care model and provides services through not-for-profit Primary Health Organisations (PHOs). PHOs, together with their District Health Boards (DHBs), contributing service providers, and local communities, are responsible for the care of their enrolled populations. The Ministry of Health (MoH) is streamlining information sharing in this environment through improvements to computer based information systems (IS). By providing health professionals with improved access to required information within an appropriate time frame, services can be targeted efficiently and effectively and patient health outcomes potentially improved. However, the adoption of IS in health care has been slower than in other industries. Therefore, a thorough knowledge of health care professionals’ attitudes to, and use of, available IS is currently needed to contribute to the development of appropriate systems. This research employs a multiple case study strategy to establish the usage of IS by three New Zealand PHOs and their member primary health care providers (PHPs), with a focus on the role of IS in clinical decision support (CDS). A mixed method approach including semi-structured interviews and postal surveys was used in the study. Firstly, the research develops and applies a survey tool based on an adaptation of an existing framework, for the study of IT sophistication in the organisations. This provides the foundation for an in-depth study of the use of computerised CDS (eCDS) in the PHO environment. Secondly, a conceptual model of eCDS utilisation is presented, illustrating the variation of eCDS use by member general practitioner (GP) practices within individual organisations. Thirdly, five areas of importance for improving eCDS utilisation within PHO’s are identified, contributing information of use to organisations, practitioners, planners, and systems developers. Lastly, the research provides a structure for the study of the domain of eCDS in PHOs by presenting a research approach and information specific for the area.