ORIGINAL ARTICLE Alignment of an intra-operating management process to a health information system: a Lean analysis approach Soudabeh Khodambashi 1 Received: 13 December 2014 / Accepted: 27 May 2015 / Published online: 18 June 2015 Ó Springer-Verlag London 2015 Abstract Health information systems (HISs) are widely used in the healthcare domain for different purposes. To assess the integration between the newly applied HIS and the clinical process, an evaluation of both is necessary. This study focuses on the evaluation of a HIS adoption in the field of intra-operating management in the anesthesia process in heart operation. The HIS which is known as ‘‘IntelliVue Clinical Information Portfolio’’ (ICIP) was designed to assist anesthetists in the pre-operating and intra-operating management process. According to the anesthetist’s feedback, some incidents were identified: The patient’s vital signs recorded in the system, during the intra-operating process, have not been recorded from the beginning of the operation. To investigate the root of the problems and delays, we conducted a case study and applied the Lean method to the intra-operating manage- ment process. This paper represents the case study and the application of the Lean method in intra-operating man- agement process after ICIP implementation. We applied the value stream map and the A3 method as the common tools of the Lean method to evaluate how the ICIP and clinical process fit are integrated. Application of Lean concept increased process integration which resulted in higher ‘‘value-added’’ activities to the patients. In addition, analysis of the process by Lean method identified the areas for improvement which reduced the ‘‘non-value-added’’ activities. Based on the findings, in order to increase inte- gration and alignment of implemented HISs to clinical workflow, we recommend evaluating the implemented HISs and clinical process in unison. Keywords Lean method Á Health information systems Á Anesthesia process Á Heart operation 1 Introduction Healthcare organizations have adopted health information systems (HISs) in their processes to manage, store and transmit information related to the health of individuals. HIS can play important roles in healthcare organizations and their clinical workflows; they can manage healthcare- related tasks and data management in an efficient way. HISs vary from a simple data management system to complex systems that assist clinicians in making clinical decisions. The aim of HIS is to improve efficiency and quality of health care. However, the evaluation results in the domain of HIS implementation and its outcome were not neces- sarily positive [1]. For example, a 45 % failure rate of information systems, due to user resistance, has been reported [2–4]. The reasons of HIS failures are not only rooted in technological issues and may be explained by various reasons, other than technological problems [5]. Hence, evaluation of the clinical process, after HIS adop- tion, to analysis alignment of the clinical workflow to the implemented information system is required [6, 7]. It is necessary to evaluate the implemented HIS to the site- specific situation to measure whether the best results and performance from the application of HIS have been achieved. Therefore, the feedback and suggestion of the main users who interact with HIS are important to & Soudabeh Khodambashi soudabeh@idi.ntnu.no 1 Norwegian University of Science and Technology (NTNU), Sem Sælandsvei 7-9, Trondheim, Norway 123 Pers Ubiquit Comput (2015) 19:689–698 DOI 10.1007/s00779-015-0853-0