Organizational Dynamics of Sustainable eHealth Implementation: A Case Study of eHMIS

Successful implementation of electronic health (eHealth) is affected by several interrelated factors that go beyond technological elements. Economic, social (human) and environmental (organizational) factors significantly influence the sustainability of eHealth systems. Because of organizational factors, the same eHealth system can exhibit different success level in different healthcare institutions. Organizational culture, structure, resources, work process flow, leadership and management support are the key elements of organizational factors in the process of eHealth implementation. These organizational factors can deter the acceptance of eHealth technology if not carefully considered in the process of eHealth implementations. In this research study, we seek to understand the elements of an organizational factor that influence eHealth implementation and to study their dynamic interactions with technological dimensions. Healthcare organization is a complex system that involves nonlinear interaction among organizational elements that keep changing over time. A conceptual framework developed to describe the organizational dynamic of eHealth implementation illustrates nonlinearity through feedbacks. A case study approach is used to learn the holistic characteristics of organizational factors during the implementation of Electronic Health Management Information System (eHMIS) in Ethiopia. The conceptual framework is tested with data collected from two separate focus group discussion sessions with the implementers and owners of eHMIS. A system dynamics research simulation applied in this study is an appropriate method to enhance the learning process of a complex system. Finally, a causal loop diagram (CLD) of organizational dynamics is developed from the focus group data, literature and eHMIS implementation documents review.