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Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center

Affiliations of the authors: Institute of Health Policy and Management, Erasmus University Medical Center, Rotterdam, The Netherlands (JA, MB); Nijmegen School of Management, Radboud University Nijmegen, Nijmegen, The Netherlands (HD).

Correspondence and reprints: Jos Aarts, MSc, Institute of Health Policy and Management, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; e-mail: <j.aarts{at}bmg.eur.nl>.

Received for publication: 03/27/03; accepted for publication: 11/24/03.

Most studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of "emergent change," they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus.