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J Am Med Inform Assoc. 2017 Jan;24(1):182-187. doi: 10.1093/jamia/ocw037. Epub 2016 Apr 23.

Ten key considerations for the successful optimization of large-scale health information technology.

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  • 1Chief Scientist Office Postdoctoral Fellow, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
  • 2Professor of Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA.
  • 3Professor of Primary Care Research and Development and Co-Director, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK.


Implementation and adoption of complex health information technology (HIT) is gaining momentum internationally. This is underpinned by the drive to improve the safety, quality, and efficiency of care. Although most of the benefits associated with HIT will only be realized through optimization of these systems, relatively few health care organizations currently have the expertise or experience needed to undertake this. It is extremely important to have systems working before embarking on HIT optimization, which, much like implementation, is an ongoing, difficult, and often expensive process. We discuss some key organization-level activities that are important in optimizing large-scale HIT systems. These include considerations relating to leadership, strategy, vision, and continuous cycles of improvement. Although these alone are not sufficient to fully optimize complex HIT, they provide a starting point for conceptualizing this important area.


Health policy value; leadership; quality of health care; safety

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