eHealth Observatory


Clinical Adoption Framework

The original Infoway BE Framework took a micro view of HIS by excluding contextual and implementation issues. Since many jurisdictions are still in early HIS deployment stages, other ways to make sense of HIS implementation are needed. Over the past few years, we have explored alternative models and conducted field studies to extend this BE framework. In 2009, drawing on these initial findings, we proposed an extended BE framework with a set of propositions that include a meso view to address the people, organization, network and implementation dimensions, and a macro view to address the contextual dimensions of technology standard, funding/incentive, legislation/policy and professional practice. Since then, the factors have been further refined to establish the current Clinical Adoption (CA) Framework (below).

Clinical Adoption Framework


Micro View (from the original BE Framework):

  • Quality of information, system and service associated with an HIS
  • Use and user satisfaction
  • Net benefits in terms of care quality, productivity and access

Meso View addresses the following dimensions that have a direct effect on micro-level adoption of HIS by clinicians:

  • People
  • Organization
  • HIS implementation

Macro View addresses the following environmental dimensions which influence the effect of meso-level factors for adoption:

  • Healthcare standards
  • Funding and incentives
  • Legislation/policy and governance
  • Societal/political/economic trends

Improvements in quality, use and net benefits experienced at the micro level can be expected to be magnified when there is alignment between meso and micro dimensions. Further, higher adoption can be expected if the organization’s efforts are aligned with the micro factors listed above.  

Lau F, Price M, Keshavjee K. From benefits evaluation to clinical adoption – Making sense of health information system success. Healthcare Quarterly 2011;14(1):39-45.