A health informatics in-depth evaluation study of the rural, across-distance implementation of a health information system: Implementing in the wild.

Authors

Kerin Robinson, Simon Barraclough

Published in

Health information management : journal of the Health Information Management Association of Australia. Pages 18333583261483160. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

This study involved the across-distance implementation of a Patient Administration System (PAS) in rural Australia, led by three health information managers (HIMs). The setting was a vast, rural health district with 10 widely dispersed health collectives ('agencies'), each encompassing a hospital and up to five additional facilities that delivered acute, rehabilitation, residential aged care, bush nursing and/or community health services to their rural and semi-rural populations.
The research aimed to examine, contemporaneously, the across-distance PAS implementation work of a team of HIMs.
This qualitative research adopted a bounded case study approach utilising the ethnographic methods of unobtrusive observation of the project committees (Steering Committee, Project Managers' Committee, Team Leaders' Committee) and in-depth interviews with the HIM team and other key actors. Temporally, the research primarily centred on the lead-up to Go-Live, via point-in-time snapshots and shadowing of the HIM team's work at different junctures.
The HIM team enacted alignment with typical, health system implementation stages. Problems encountered were: Go-Live timings; consultation on design of referral functions; poor or absent report, referral, and billing functionalities; and universal health IT implementation issues of insufficient staffing resources and too-tight timeframes. Constantly problem-solving to (re-)balance tensions between the agencies' desire for an effective PAS and the realities of a government-imposed, standardised system, the HIMs imagined the new PAS and its impacts on the agencies' data collection processes, day-to-day operations, and patient care. From a distance, they intensively and collectively imagined and (re-)ordered technology, systems, policies, procedures, work and documentation practices, patient and information flows, and adjunct services, to establish a PAS with integrity and address the requirements of the purchaser agencies' directors, management, clinicians, HIMs, and finance and administrative staff.
The HIM team applied knowledge of healthcare systems and processes, mitigated risk, and mediated the technology and the stakeholders' worlds. Their collaborative work to establish PAS-related order was congruent with our previous findings on the work of HIMs, Australia-wide.Implications for health information management practice:This case study research highlights the significance of HIMs' deep professional knowledge of (a) health informatics and information systems, and (b) healthcare agencies' data requirements, practices, and artefacts.

PMID:
42755389
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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