Implementing point-of-care medical information systems into surgical practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research

Abstract Background: Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the consolidated framework for implementation research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. Methods: Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons who received an intervention that provided free-access to UpToDate and Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. Results: Barriers included a lack of seniority buy-in and engaging leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions focused on intervention adaptability including both locally relevant adaptations and visual representation of information available via POCMIS. Conclusions: In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to overcome barriers identified in our data. Cultural barriers, such as the culture of assumption that emerged in our data, should be identified using rapid assessment procedures (RAP) prior to implementing similar interventions to minimize their negative impact on successful implementation. RAP may also help researchers identify key leaders in the implementation climate, allowing them to engage those leaders in the implementation process and ensure the presence of a learning climate during and following the intervention. Using RAP to guide the planning, engaging, and executing stages of the implementation process may not only help eliminate cultural barriers prior to them inhibiting successful implementation, but may also encourage regional- and specialty-specific adaptations necessary for success.