Electronic health records (EHRs) are implemented by many health care organizations as a potential service solution. Despite the appeal of EHRs, failure in their implementation can lead to negative consequences, ranging from the loss of money to reputation damage, for health care providers. However, the causes of this problem have not attracted the attention of a sufficient number of researchers. This paper aims to investigate this phenomenon objectively and subjectively in a public context using an interview‐based qualitative approach supported by archival data and records of a real‐world failed EHR project. The results show that the factors influencing failure are divergent and include technical and managerial issues. In particular, the timing and duration of the training as well as the integration of EHR with the enterprise systems were found to be the strongest influencing factors, followed by reasons related to the software design (eg, a lack of required pharmacy functionality) and software people management (eg, resistance to change). The paper also discusses points related to EHR development and design, such as the development paradigm, data quality and validation, architecture for security, and source code naming convention.

中文翻译：

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医疗软件设计与实现——一个项目失败案例

许多医疗保健组织将电子健康记录 (EHR) 作为一种潜在的服务解决方案实施。尽管 EHR 具有吸引力，但其实施失败可能会给医疗保健提供者带来负面后果，从金钱损失到声誉受损。然而，造成这一问题的原因并没有引起足够多的研究人员的关注。本文旨在使用基于访谈的定性方法在公共环境中客观和主观地调查这一现象，该方法由档案数据和现实世界失败的 EHR 项目的记录支持。结果表明，影响失败的因素各不相同，包括技术和管理问题。特别是，培训的时间和持续时间以及 EHR 与企业系统的集成被发现是最强的影响因素，其次是与软件设计相关的原因（例如，缺乏所需的药房功能）和软件人员管理（例如，抗拒改变）。本文还讨论了与 EHR 开发和设计相关的要点，例如开发范式、数据质量和验证、安全架构和源代码命名约定。