Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 17, 2019
Date Accepted: Apr 19, 2020
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Developing and applying a formative evaluation framework for health information technology implementations – The Technology, People, Organizations and Macro-environmental factors (TPOM) Framework
ABSTRACT
Background:
There is currently a lack of comprehensive, yet intuitive and usable formative evaluation frameworks of health information technology (HIT) implementations.
Objective:
We therefore sought to develop and apply such a framework: the Technology, People, Organizations and Macro-environmental factors (TPOM) Framework.
Methods:
We drew on qualitative data from three national formative evaluations of different HIT (i.e. electronic health record, electronic prescribing and clinical decision support functionality) interventions. The combined dataset comprised 703 semi-structured interviews, 663 hours of observations and 864 documents gathered from a range of care settings across NHS England and NHS Scotland. Data analysis took place over a period of 10 years guided by a framework we iteratively developed that was informed by the existing evidence base.
Results:
TPOM dimensions are intimately related and each include a number of sub-themes that evaluators need to consider. Whilst technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways these are used by organizations and staff.
Conclusions:
The TPOM Framework supports formative evaluations of health IT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TOPM Framework to determine its value.
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