JMIR Publications

ABSTRACT

Background:

Medication errors are a leading cause of preventable harm in healthcare. Electronic Medication Systems (EMS) are promoted to enhance patient safety and efficiency, yet robust evidence on hard clinical endpoints remains scarce. Furthermore, many digital health projects fail not due to technological deficits, but due to flawed implementation strategies that neglect user needs and complex clinical workflows. This gap between the potential of innovations and their practical benefit in routine care highlights the importance of implementation science. Given the inherent risks of medication management, rigorous implementation of EMS is therefore not merely a technical challenge, but a patient safety imperative.

Objective:

This case study aims to provide a detailed, structured description of the successful implementation of an EMS at one of Europe’s largest university hospitals. We describe our peer-based, patient-centric implementation strategy with a unit-ward-based approach, report on its outcomes, and derive transferable lessons to guide future digital health projects.

Methods:

We conducted a descriptive case study of the transition from a heterogeneous paper-based medication process to a unified EMS. The implementation followed a phased, unit-to-ward-based rollout strategy across three hospital campuses. A multidisciplinary, peer-based implementation team (comprising physicians, nurses, pharmacists, medical IT and project-management) utilized a multimodal communication strategy, mandatory online training, and intensive on-site support, including a patient-centric transfer of all medication charts. The implemented strategies were mapped post-hoc to the Expert Recommendations for Implementing Change (ERIC) taxonomy, while the Consolidated Framework for Implementation Research (CFIR) was used to systematically contextualize the implementation setting.

Results:

Over a 15-month period, the transition to the EMS was successfully completed on 103 inpatient wards (approximately 1700 beds) and in around 20 outpatient departments. To date, over 4000 clinical staff members (1600 physicians and 2400 nurses) use the EMS regularly. The implementation process showed strong protocol adherence, with positive user feedback and subsequent requests for inclusion of originally optional areas such as day-clinics. A post-hoc analysis revealed that our approach aligned with a majority of ERIC strategies, with 45 of 73 (61.64%) recommendations fully incorporated and 8 (10.96%) partially incorporated.

Conclusions:

A phased, unit-to-ward implementation approach, driven by a multidisciplinary peer-based team, proved effective for deploying complex clinical software in a large tertiary care setting. The alignment of our practice-driven approach with established implementation science strategies like ERIC underscores their value in ensuring the success and sustainability of digital transformation in healthcare.