Evaluating computerised health information systems: hard lessons still to be learnt

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Abstract
Development of the project The project to install a computerised integrated hospital information system in Limpopo (Northern) Province (figure) was the biggest medical informatics project in Africa. The project was initiated in response to a national strategy to restructure health care after the 1994 elections. Changes included shifting resources from tertiary and secondary care to primary care, devolution of management to district level, and redistribution of resources in response to perceived geographical and sectoral need. The success of these initiatives required managerial, administrative, and clinical processes that were efficient, effective, and equitable. Adequate information was considered essential, not only to facilitate the tasks but also for short and long term monitoring. Limpopo Province has 42 hospitals, comprising two mental health institutions, eight regional hospitals (two acting as a tertiary complex with teaching responsibilities), and 32 district hospitals. The area is one of the poorest in South Africa. IBM was awarded the contract for implementation at a cost of 134m Rand (nearly £14m), which represented 2.5% of the province's health and welfare annual budget.