25gmds14510.3205/25gmds145urn:nbn:de:0183-25gmds1456Meeting AbstractBridging Technology and Organizational Change: A Context-Sensitive Strategy for Mandatory HIS Implementation in a University HospitalGaulGaulCarolinaCCharité – Universitätsmedizin Berlin, Berlin, GermanyauthorMoschMoschLinaLCharité – Universitätsmedizin Berlin, Berlin, GermanyauthorBalzerBalzerFelixFCharité – Universitätsmedizin Berlin, Berlin, GermanyauthorComptonComptonFriederikeFCharité – Universitätsmedizin Berlin, Berlin, GermanyauthorGerman Medical Science GMS Publishing House
Düsseldorf
610hospital information systemsimplementation sciencecontext sensitivity20251103englThis is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).M0631145Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie70. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)PS 7: IT-Infrastruktur 2Jena2025090720250911Abstr. 233TextIntroduction: The implementation of hospital information system (HIS) is often framed as a technological upgrade, yet it fundamentally alters clinical workflows and organizational culture – particularly in mandatory settings. At a large German university hospital, a vendor based HIS will be introduced by 2028, affecting more than 23,000 staff across 100+ specialist departments. Evidence shows that mandatory implementations may provoke resistance and tensions if contextual factors are not adequately addressed , . This study protocol adapts the Basel Approach for Contextual Analysis in Implementation Science (BANANA) to systematically identify and address these factors during the pre-implementation phase. Methods: The study follows a multi-method design based on BANANA’s six-step framework .A theoretical framework will be selected through expert consensus among implementation researchers. A hermeneutic literature review will be conducted alongside insights from internal project documents. Stakeholders – including clinicians, project staff, and implementation experts – will be recruited through internal communication channels and professional networks. Semi-structured interviews will explore perceived contextual barriers and facilitators. Based on the interview findings, tailored implementation strategies will be selected using the Expert Recommendations for Implementing Change (ERIC) . The contextual analysis process and its findings will be reported transparently in line with implementation science standards. Figure 1 Results: The study is expected to classify key contextual barriers and produce stakeholder-informed strategies tailored to the hospital’s environment. These outcomes will form the basis of an implementation guide that addresses the complexities of a mandatory HIS rollout in a university hospital. Discussion: This research is situated at the intersection of medical informatics and implementation science, addressing a highly complex, mandatory digital transformation at a German university hospital. Such transformations require not only interoperability and standardization of data flows across departments but also deep integration into clinical routines. These technical challenges – ranging from infrastructure compatibility to interface usability and system reliability – can significantly disrupt clinical processes if not managed thoughtfully. Despite the technological sophistication of the HIS, resistance, low adoption, and workflow misalignment remain persistent risks, particularly in mandatory implementation settings , . This is precisely where implementation science adds value: by providing structured methodologies to understand context, engage stakeholders, and tailor implementation strategies to real-world conditions. Using the BANANA approach for contextual analysis and drawing upon prominent implementation frameworks and tools, this project contributes a context-sensitive, user-informed guide for implementation within a complex environment , , . Ultimately, the integration of implementation science into medical informatics is not just beneficial – it is essential. Only through interdisciplinary collaboration can we ensure that complex digital health technologies are not only technically sound but also usable, accepted, and effective in practice. Conclusion: Operationalizing BANANA in a large clinical setting offers a structured approach to early-stage contextual analysis. By identifying barriers and co-designing solutions with stakeholders, this study aims to reduce resistance and support successful HIS adoption. The results may inform other large-scale digital health implementations.The authors declare that they have no competing interests.The authors declare that a positive ethics committee vote has been obtained.Boonstra AVersluis AVos JFImplementing electronic health records in hospitals: a systematic literature review2014BMC Health Serv Res370Boonstra A, Versluis A, Vos JF. Implementing electronic health records in hospitals: a systematic literature review. BMC Health Serv Res. 2014 Sep 4;14(1):370. DOI: 10.1186/1472-6963-14-370http://dx.doi.org/10.1186/1472-6963-14-370Brown SAMassey APMontoya-weiss MMBurkman JRDo I really have to? User acceptance of mandated technology2002Eur J Inf Syst283-95Brown SA, Massey AP, Montoya-weiss MM, Burkman JR. Do I really have to? User acceptance of mandated technology. Eur J Inf Syst. 2002 Sep;11(4):283-95.Damschroder LJReardon CMWiderquist MALowery JThe updated Consolidated Framework for Implementation Research based on user feedback2022Implement Sci75Damschroder LJ, Reardon CM, Widerquist MA, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022 Oct 29;17(1):75. DOI: 10.1186/s13012-022-01245-0http://dx.doi.org/10.1186/s13012-022-01245-0Mielke JLeppla LValenta SZullig LLZúñiga FStaudacher SUnraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project2022Implement Sci Commun102Mielke J, Leppla L, Valenta S, Zullig LL, Zúñiga F, Staudacher S, et al. Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project. Implement Sci Commun. 2022 Oct 1;3(1):102. DOI: 10.1186/s43058-022-00354-7http://dx.doi.org/10.1186/s43058-022-00354-7Powell BJWaltz TJChinman MJDamschroder LJSmith JLMatthieu MMA refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project2015Implement Sci21Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015 Feb 12;10(1):21. DOI: 10.1186/s13012-015-0209-1.http://dx.doi.org/10.1186/s13012-015-0209-1.011