Implementation and Integration Gaps in Hospital Information Technology Platforms at the National Hospital of Sri Lanka: A Descriptive Study

Abstract

Aims: To evaluate the implementation status, utilisation gaps, and integration challenges of key health information technology platforms at the National Hospital of Sri Lanka, and to identify priority issues and propose evidence-informed strategies to improve system integration and hospital-wide adoption. Study Design: Descriptive institutional study with a qualitative dominant mixed-methods approach. Place and Duration of Study: National Hospital of Sri Lanka, Colombo, between May 2024 and October 2024. Methodology: Data were collected using multiple methods, including semi-structured key informant interviews, staff discussions, field observations, and document review. Participants included consultants in health informatics, medical officers, radiology and laboratory staff, and frontline healthcare workers. A consensus-based prioritisation process using the Nominal Group Technique was applied to identify the most critical implementation issue. Root cause analysis was conducted using a fishbone framework. Qualitative data were analysed using thematic analysis with triangulation across data sources. Results: The assessment revealed uneven implementation of digital platforms across the hospital. The hospital health information management system was partially implemented, mainly in outpatient and emergency settings, while inpatient utilisation remained minimal. The picture archiving and communication system was fully operational and widely used, demonstrating high acceptance and improved access to imaging. A hospital-wide laboratory information management system was absent. Six major implementation gaps were identified, with fragmented and inconsistent system utilisation ranked as the most critical issue. Root cause analysis identified contributing factors across people, process, environment, technology, and policy domains, including inadequate infrastructure, limited training, lack of standardised workflows, poor interoperability, and delays in administrative and funding processes. Conclusion: Despite the presence of multiple digital platforms, their fragmented and inconsistent utilisation limits the effectiveness of the hospital’s digital health ecosystem. Addressing these challenges requires targeted interventions, including expansion of the hospital health information management system across all clinical units, strengthening interoperability between platforms, ensuring minimum information technology infrastructure and technical support, implementing standardised workflows supported by institutional policies, and enhancing staff training and engagement. These measures are essential to achieve effective and sustainable digital transformation in large tertiary care hospitals.