The implementation of clinical information systems is demanding, particularly in hospitals, where reliable and well functioning information and communication tools are critical. In this paper we present different approaches to understanding and identifying challenges concerning the implementation of new electronic patient chart functionality. The context of the study was the development and implementation of the new system, which was withdrawn shortly after deployment in a medium-sized University Hospital. One year prior to the deployment we performed an observational study of current information and communication system usage in two hospital wards. Eight months later we conducted a usability test of the new functionality in a laboratory configured as a hospital ward. Four months after system deployment, the studies were followed up by interviews with healthcare personnel, members from the hospital implementation project group, and vendor representatives. The results of the studies show how the different approaches identify and reveal important issues that, if they had been taken into account, could have increased the chance of successful implementation of the system.
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