1
|
Brunner J, Cannedy S, McCoy M, Hamilton AB, Shelton J. Software is Policy: Electronic Health Record Governance and the Implications of Clinical Standardization. J Gen Intern Med 2023; 38:949-955. [PMID: 37798574 PMCID: PMC10593671 DOI: 10.1007/s11606-023-08280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) implementations, whether replacing paper or electronic systems, are major social and organizational transformations. Yet studies of EHR-to-EHR transitions have largely neglected to elucidate accompanying social and organizational changes. One such underexplored change is the standardization of clinical practice in the context of EHR transitions. The Department of Veterans Affairs (VA) has begun a decade-long process of replacing the approximately 130 separate versions of its homegrown EHR with a single commercial EHR system. This provides an opportunity to explore the standardization of clinical practice amidst an EHR transition. OBJECTIVE To identify, in the context of a large-scale EHR transition, (1) the scope and content of clinical standardization and (2) the anticipated implications of such standardization. DESIGN Qualitative study. PARTICIPANTS Twenty-nine members of VA councils established for the EHR transition. APPROACH We conducted semi-structured interviews, which were professionally transcribed, and analyzed first using rapid analysis methods, followed by coding and content analysis. KEY RESULTS Clinical standardization across facilities was a central goal of the EHR transition, encompassing computerized recommendations, order sets, professional roles/permissions, and clinical documentation. The anticipated implications of this standardization include (i) potential efficiency gains, with less duplicated effort across facilities; (ii) expanded bureaucracy; and (iii) increased uniformity, reducing both wanted and unwanted variation in care. CONCLUSIONS EHR systems shape a wide range of clinical processes, particularly in a large organization like VA with a long history of EHR use. This makes standardization of EHR content a powerful mechanism for standardizing clinical practice itself, which can bring dramatic collateral consequences. Organizations undergoing EHR transitions need to recognize the important role that clinical standardization plays by treating EHR transitions as major organizational transformations in the governance of clinical practice.
Collapse
Affiliation(s)
- Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Shay Cannedy
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthew McCoy
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeremy Shelton
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Teixeira MJC, Khouri M, Martinez E, Bench S. Implementing a discharge process for patients undergoing elective surgery: Rapid review. Int J Orthop Trauma Nurs 2023; 48:101001. [PMID: 36805314 DOI: 10.1016/j.ijotn.2023.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/14/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hospital discharge is a 'vulnerable stage' in care. A delayed, inappropriate or poorly planned discharge increases hazards and costs, inhibiting recovery, and often leading to unplanned readmission. New discharge processes could boost practice, reduce the length of stay, and, consequently, reduce costs and improve patients' quality of life. AIM To identify technology based interventions that have been implemented to facilitate a safe and timely discharge procedure after elective surgery, and to describe implementation barriers and facilitators and patient satisfaction. METHOD This rapid review followed a restricted systematic review framework, searching Medline, EMBASE, CINAHL, PsychINFO, and ClinicalTrials.gov. for relevant studies published from 2015 to 2021 in English. RESULTS Eleven studies were included. Most interventions were machine-learning-based, and only one study reported patient involvement. Effective leadership, team work and communication were stated as implementation facilitators. The main barriers to implementation were: lack of support from leaders, poor clinical documentation, resistance to change, and financial and logistical concerns. None of the studies evaluated patient satisfaction. CONCLUSIONS Findings highlight factors that support the implementation of technology based interventions aimed at a safe and timely discharge process following elective surgery. Nurses play an important role in the provision of information, and in the development and implementation of discharge processes.
Collapse
Affiliation(s)
- Maria J C Teixeira
- Nursing Research Department, Royal National Orthopaedic Hospital NHS Trust, London, UK; London South Bank University, London, UK; Nuffield Health, The Manor Hospital, Oxford, UK.
| | - Ma'ali Khouri
- Institute of Orthopaedics Library, University College London, London, UK
| | - Evangeline Martinez
- Functional and Restorative Services, London Spinal Cord Injury Research Centre, Royal National Orthopaedic Hospital NHS Trust, London, UK; University College London, London, UK
| | - Suzanne Bench
- London South Bank University, London, UK; ACORN A Centre of Research for Nurses & Midwives, Guys and St Thomas's NHS Trust, Lond, UK
| |
Collapse
|
3
|
Leung T, Anderson S, Mozaffar H, Elizondo A, Geiger M, Williams R. Socio-Organizational Dimensions: The Key to Advancing the Shared Care Record Agenda in Health and Social Care. J Med Internet Res 2023; 25:e38310. [PMID: 36701190 PMCID: PMC9912150 DOI: 10.2196/38310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 02/02/2023] Open
Abstract
Integrating health and social care delivery with the help of digital technologies is a grand challenge. We argue that previous attempts have largely failed to achieve their objectives because implementers and decision makers disregard the complex socio-organizational dimensions of change associated with initiatives. These include structural and organizational complexity inhibiting the development of shared care pathways; professional jurisdictions, interests, and expertise; and existing data and governance structures. We provide an overview of those dimensions that can inform strategic decisions going forward, thereby contributing to the chances of success of shared care initiatives.
Collapse
Affiliation(s)
| | - Stuart Anderson
- School of Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrey Elizondo
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Marcia Geiger
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
4
|
Cen ZF, Tang PK, Hu H, Cavaco AC, Zeng L, Lei SL, Ung COL. Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services. BMJ Open 2022; 12:e066246. [PMID: 36418133 PMCID: PMC9684285 DOI: 10.1136/bmjopen-2022-066246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The study aimed to determine how eHealth was adopted in pharmaceutical care (PC), the outcome reported and the contextual factors. DESIGN Systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Literature was searched in six databases including PubMed, Scopus, Medline, Web of Science, Science Direct and China National Knowledge Infrastructure. ELIGIBILITY CRITERIA Studies which reported the usage experiences of eHealth in any aspects of PC by pharmacists during the COVID-19 pandemic, written in English or Chinese, and published in peer-reviewed journals between December 2019 and March 2022 were included. Opinion articles, conference abstracts, correspondence, letters and editorials were excluded. DATA EXTRACTION AND SYNTHESIS The literature search was completed on 15 April 2022. Two researchers independently conducted the literature search and extracted the data into an Excel table informed by the logic model with the key components of goals, input, activities, output and contextual factors. RESULTS Forty-three studies were included in this review. During the COVID-19 pandemic, hospital pharmacists, community pharmacists and specialist pharmacists in 17 countries continued to educate, consult, monitor and manage the patients and the general public via phone calls, videoconferences, mobile applications, social media, websites and/or enhanced interoperability of electronic medical records. Assuring the continuity of pharmacy care, reduced need for hospital visits, and improved work accuracy and efficiency were the benefits of eHealth mostly reported. Contextual factors affecting the adoption of eHealth were multifaceted, prompting supporting actions at the levels of government, hospital/pharmacy, pharmacists and patients. CONCLUSION This study revealed the wide adoption of eHealth in PC during the pandemic and the emerging evidence for its importance. Proper adoption of eHealth will help reshape the mode of pharmacy services to ensure continuity, quality and efficiency of care amid the challenges of the pandemic. PROSPERO REGISTRATION NUMBER CRD42022299812.
Collapse
Affiliation(s)
- Zhi Feng Cen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Pou Kuan Tang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
| | | | - Luoxin Zeng
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Sut Leng Lei
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
| |
Collapse
|
5
|
Currie WL, Seddon JJJM. Stakes, positions and logics: An institutional field analysis of cross-border health IT policy. JOURNAL OF INFORMATION TECHNOLOGY 2021. [DOI: 10.1177/02683962211040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The concepts field and habitus are used widely and variably in institutional theory. The intellectual antecedents are found in the work of the French Sociologist, Pierre Bourdieu. This study presents a field-level analysis of pan-European policy on cross-border health information technology. Using field theory and institutional theory, we situate field as a multi-level concept which extends institutional and organizational levels of analysis. Empirical data is gathered from European policymakers, health professionals and patient advocacy groups on the diffusion of supra-national health information technology across European Member States. Findings reveal four scenarios depicting field tensions, as ideological and practical imperatives of supra-national health information technology policy mis-align with Member State health systems. This study has implications for policy-makers and other stakeholders, who seek to narrow the digital divide across health fields and sub-fields.
Collapse
|
6
|
Krasuska M, Williams R, Sheikh A, Franklin B, Hinder S, TheNguyen H, Lane W, Mozaffar H, Mason K, Eason S, Potts H, Cresswell K. Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme. BMJ Health Care Inform 2021; 28:e100429. [PMID: 34921060 PMCID: PMC8685936 DOI: 10.1136/bmjhci-2021-100429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence. AIM To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme. METHODS We conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data. RESULTS We found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors. CONCLUSION The GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transformation programmes in healthcare can stimulate local progress through protected funding, putting in place governance structures and leveraging reputational benefits for participating provider organisations, around a coherent vision of transformation.
Collapse
Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Hung TheNguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | | | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | | | | | - Henry Potts
- Institute of Health Informatics, University College London, London, UK
| | - Kathrin Cresswell
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| |
Collapse
|
7
|
Martin PM. NHS blood tube shortage reminds us of our waste. BMJ 2021; 375:n2401. [PMID: 34625449 DOI: 10.1136/bmj.n2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Martani A, Geneviève LD, Egli SM, Erard F, Wangmo T, Elger BS. Evolution or Revolution? Recommendations to Improve the Swiss Health Data Framework. Front Public Health 2021; 9:668386. [PMID: 34136456 PMCID: PMC8200489 DOI: 10.3389/fpubh.2021.668386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Facilitating access to health data for public health and research purposes is an important element in the health policy agenda of many countries. Improvements in this sense can only be achieved with the development of an appropriate data infrastructure and the implementations of policies that also respect societal preferences. Switzerland is a revealing example of a country that has been struggling to achieve this aim. The objective of the study is to reflect on stakeholders' recommendations on how to improve the health data framework of this country. Methods: We analysed the recommendations collected as part of a qualitative study including 48 expert stakeholders from Switzerland that have been working principally with health databases. Recommendations were divided in themes and subthemes according to applied thematic analysis. Results: Stakeholders recommended several potential improvements of the health data framework in Switzerland. At the general level of mind-set and attitude, they suggested to foster the development of an explicit health data strategy, better communication and the respect of societal preferences. In terms of infrastructure, there were calls for the creation of a national data center, the improvement of IT solutions and the use of a Unique Identifier for patient data. Lastly, they recommended harmonising procedures for data access and to clarify data protection and consent rules. Conclusion: Recommendations show several potential improvements of the health data framework, but they have to be reconciled with existing policies, infrastructures and ethico-legal limitations. Achieving a gradual implementation of the recommended solutions is the preferable way forward for Switzerland and a lesson for other countries that are also seeking to improve health data access for public health and research purposes.
Collapse
Affiliation(s)
- Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Sophia Mira Egli
- Master Student, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Frédéric Erard
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
9
|
Williams R, Sheikh A, Franklin BD, Krasuska M, Nguyen HT, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts HWW, Cresswell K. Using Blueprints to promote interorganizational knowledge transfer in digital health initiatives-a qualitative exploration of a national change program in English hospitals. J Am Med Inform Assoc 2021; 28:1431-1439. [PMID: 33706378 PMCID: PMC8480174 DOI: 10.1093/jamia/ocab020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The Global Digital Exemplar (GDE) Program is a national attempt to accelerate digital maturity in healthcare providers through promoting knowledge transfer across the English National Health Service (NHS). “Blueprints”—documents capturing implementation experience—were intended to facilitate this knowledge transfer. Here we explore how Blueprints have been conceptualized, produced, and used to promote interorganizational knowledge transfer across the NHS. Materials and Methods We undertook an independent national qualitative evaluation of the GDE Program. This involved collecting data using semistructured interviews with implementation staff and clinical leaders in provider organizations, nonparticipant observation of meetings, and key documents. We also attended a range of national meetings and conferences, interviewed national program managers, and analyzed a range of policy documents. Our analysis drew on sociotechnical principles, combining deductive and inductive methods. Results Data comprised 508 interviews, 163 observed meetings, and analysis of 325 documents. We found little evidence of Blueprints being adopted in the manner originally conceived by national program managers. However, they proved effective in different ways to those planned. As well as providing a helpful initial guide to a topic, we found that Blueprints served as a method of identifying relevant expertise that paved the way for subsequent discussions and richer knowledge transfers amongst provider organizations. The primary value of Blueprinting, therefore, seemed to be its role as a networking tool. Members of different organizations came together in developing, applying, and sustaining Blueprints through bilateral conversations—in some circumstances also fostering informal communities of practice. Conclusions Blueprints may be effective in facilitating knowledge transfer among healthcare organizations, but need to be accompanied by other evolving methods, such as site visits and other networking activities, to iteratively transfer knowledge and experience.
Collapse
Affiliation(s)
- Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Marta Krasuska
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hung The Nguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | | | | |
Collapse
|
10
|
Ede J, Vollam S, Darbyshire JL, Gibson O, Tarassenko L, Watkinson P. Non-contact vital sign monitoring of patients in an intensive care unit: A human factors analysis of staff expectations. APPLIED ERGONOMICS 2021; 90:103149. [PMID: 32866689 DOI: 10.1016/j.apergo.2020.103149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/12/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Infra-red and thermal imaging enable wireless systems to monitor patients' vital signs and absence of wires may improve patient experiences. No studies have explored staff perceptions of the concept of this specific type of technology in the adult population. Understanding existing working systems before introducing technology could improve adoption. METHODS We conducted semi-structured interviews with Intensive Care Unit (ICU) staff exploring perceptions of wireless patient monitoring. We used the Systems Engineering Initiative for Patient Safety (SEIPS) model to guide thematic analysis. RESULTS We identified usability themes relating to staff perceptions of current patient monitoring experiences, staff perceptions of patient/relative expectations of ICU care, troubleshooting, hierarchy of monitoring, and consensus of trust. CONCLUSION The concept of wireless monitoring has perceived benefits for patients and staff. The Systems Engineering Initiative for Patient Safety model guided a systems-based exploratory evaluation. Results highlight the social and environmental factors which may influence usability, adoption, or abandonment of wireless technology in the ICU.
Collapse
|
11
|
Heslop PA, Davies K, Sayer A, Witham M. Making consent for electronic health and social care data research fit for purpose in the 21st century. BMJ Health Care Inform 2020; 27:bmjhci-2020-100128. [PMID: 32616478 PMCID: PMC7333808 DOI: 10.1136/bmjhci-2020-100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Philip Anthony Heslop
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom .,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Karen Davies
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom
| | - Avan Sayer
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom.,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Miles Witham
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom.,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
12
|
Cresswell K, Sheikh A, Franklin BD, Krasuska M, Nguyen HT, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts HWW, Williams R. Theoretical and methodological considerations in evaluating large-scale health information technology change programmes. BMC Health Serv Res 2020; 20:477. [PMID: 32460830 PMCID: PMC7254705 DOI: 10.1186/s12913-020-05355-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/24/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Attempts to achieve digital transformation across the health service have stimulated increasingly large-scale and more complex change programmes. These encompass a growing range of functions in multiple locations across the system and may take place over extended timeframes. This calls for new approaches to evaluate these programmes. MAIN BODY Drawing on over a decade of conducting formative and summative evaluations of health information technologies, we here build on previous work detailing evaluation challenges and ways to tackle these. Important considerations include changing organisational, economic, political, vendor and markets necessitating tracing of evolving networks, relationships, and processes; exploring mechanisms of spread; and studying selected settings in depth to understand local tensions and priorities. CONCLUSIONS Decision-makers need to recognise that formative evaluations, if built on solid theoretical and methodological foundations, can help to mitigate risks and help to ensure that programmes have maximum chances of success.
Collapse
Affiliation(s)
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Bryony Dean Franklin
- University College London School of Pharmacy, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, London, UK
| | - Marta Krasuska
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hung The Nguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Henry W W Potts
- University College London Institute of Health Informatics, London, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
13
|
Pinto LF, Santos LJD. Electronic medical records in primary care: management of duplicate records and a contribution to epidemiological studies. CIENCIA & SAUDE COLETIVA 2020; 25:1305-1312. [PMID: 32267433 DOI: 10.1590/1413-81232020254.34132019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022] Open
Abstract
Primary health care electronic medical records were analyzedin Rio de Janeiro for two chronic diseases, namely, hypertension and diabetes, in a population-based study with a cross-sectional epidemiological design that considered the Rio de Janeiro population enrolled in Family Health Teams. Calculation of the prevalence rate was stratified by gender and age group, and the condition of the disease was measured by family doctors in their visits using the ICD-10.Except for the last two age groups (75-79 years and 80 years and over), with apparent under-registration of the diagnosed cases, a positive association was found between prevalence rates and age in both genders. The generation of objective and reliable statistical information is fundamental for local management, allowing the evaluation of demographic dynamics and the peculiarities of each territory, and assisting in the planning and monitoring of the quality of Rio de Janeiro people's records registered in each family health unit. Thus, the regular management of duplicate records in the registered user roster is essential to minimize the over-registration of clinical cases reported in the electronic medical records.
Collapse
Affiliation(s)
- Luiz Felipe Pinto
- Departamento de Medicina em Atenção Primária à Saúde, Faculdade de Medicina, Universidade Federal do Rio de Janeiro. R. Laura de Araújo 36/2º parte, Cidade Nova. 20211-170 Rio de Janeiro RJ Brasil.
| | - Leda Jung Dos Santos
- Curso de Graduação em Medicina, Centro Universitário Serra dos Órgãos. Teresópolis RJ Brasil
| |
Collapse
|
14
|
Klecun E, Zhou Y, Kankanhalli A, Wee YH, Hibberd R. The dynamics of institutional pressures and stakeholder behavior in national electronic health record implementations: A tale of two countries. JOURNAL OF INFORMATION TECHNOLOGY 2019. [DOI: 10.1177/0268396218822478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Through electronic health record implementation, national healthcare systems are aiming for care integration and enhancement. However, the path to large-scale electronic health record implementation is seldom smooth, involving multiple stakeholders with diverse interests and influences. This study proposes a framework that draws on both stakeholder and institutional theories to understand the complex dynamics of stakeholder interactions and institutional pressures over time during electronic health record systems implementation. This framework is utilized to analyze the national electronic health record programs of Singapore and England, which provide contrasting perspectives on how two top-down system implementations took place with different outcomes. Our results suggest that in the Singapore case, the presence of boundary spanners, supporting implementation agency that included IT staff from healthcare organizations, and greater engagement with medical professionals were associated with more positive dynamics of stakeholder interactions (e.g. limited pushback from professionals or the press) during electronic health record implementation than in England. Differences in the healthcare structures and systems, electronic health record project organization, and the combined influences of institutional pressures shed light on the varying implementation paths and outcomes in the two cases. This study adds to the health information technology literature through a comparative examination of the organizational and social processes during complex national healthcare integration projects. It also contributes to the institutional and stakeholder literatures in several ways, in particular by depicting the processes and outcomes of the dynamics of isomorphic pressures played out under different institutional conditions. Finally, our proposed framework provides a useful conceptual tool for analyzing such complex IT implementations across multiple stakeholders.
Collapse
Affiliation(s)
- Ela Klecun
- London School of Economics and Political Science, UK
| | - Ya Zhou
- The University of Nottingham Ningbo China, China
| | | | | | - Ralph Hibberd
- London School of Economics and Political Science, UK
| |
Collapse
|
15
|
Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06200] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundThere is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood about how, under what conditions, for which patients and in what ways these approaches may offer benefits to patients and practitioners in general practice.ObjectivesOur objectives were to review existing evidence about alternatives to face-to-face consultation; conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives; recruit eight general practices as case studies for focused ethnographic research, exploring how practice context, patient characteristics, type of technology and the purpose of the consultation interact to determine the impact of these alternatives; and synthesise the findings in order to develop a website resource about the implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.DesignMixed-methods case study.SettingGeneral practices in England and Scotland with varied experience of implementing alternatives to face-to-face consultations.ParticipantsPatients and practice staff.InterventionsAlternatives to face-to-face consultations include telephone consultations, e-mail, e-consultations and internet video.Main outcome measuresHow context influenced the implementation and impact of alternatives to the face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of consultation by different patient groups; and the intended benefits/outcomes.Review methodsThe conceptual review used an approach informed by realist review, a method for synthesising research evidence regarding complex interventions.ResultsAlternatives to the face-to-face consultation are not in mainstream use in general practice, with low uptake in our case study practices. We identified the underlying rationales for the use of these alternatives and have shown that different stakeholders have different perspectives on what they hope to achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life use of different forms of alternative, we have a clearer understanding of how, under what circumstances and for which patients alternatives might have a range of intended benefits and potential unintended adverse consequences. We have also developed a framework for future evaluation.LimitationsThe low uptake of alternatives to the face-to-face consultation means that our research participants might be deemed to be early adopters. The case study approach provides an in-depth examination of a small number of sites, each using alternatives in different ways. The findings are therefore hypothesis-generating, rather than hypothesis-testing.ConclusionsThe current low uptake of alternatives, lack of clarity about purpose and limited evidence of benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted key issues for practices and policy-makers to consider and have made recommendations about priorities for further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face consultation, such as telephone consulting, e-consultation, e-mail and video consulting.Future workWe have synthesised our findings to develop a framework and recommendations about future evaluation of the use of alternatives to face-to-face consultations.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| |
Collapse
|
16
|
Abstract
Purpose
The purpose of this paper is to address the call for more public sector empirical studies on benefits realisation (BR), to contribute to the literature on BR as a dynamic capability (DC) within the context of IT-enabled innovation in a public sector context and to highlight the challenges facing organisations if they adopt a BR competence and capability framework.
Design/methodology/approach
The empirical research conducted within this paper is an exploratory survey. Exploratory surveys are particularly useful when investigating a little known phenomenon and can help to uncover or provide preliminary evidence of association among concepts. This survey was a census of all National Health Service acute hospital trusts in England.
Findings
The study indicates that most hospitals that participated in the survey have a basic approach to BR and have yet to develop a more mature approach that would provide the strong micro-foundations of a BR capability.
Research limitations/implications
The BR framework that has been the basis of the survey is interesting in terms of its components but is limited with regards to the micro-foundations of a benefits realisation capability within an organisation. The research suggests that organisations in the public sector need to focus much more on staff development and recruitment in the area of BR to ensure that they have the appropriate skills sets for a rapidly changing environment.
Originality/value
The paper proposes a framework for BR capabilities and IT-enabled change, and suggests that although the concept of maturity is valuable when considering the micro-foundations of BR, DCs change and respond to stimuli within the external and internal environment and must be renewed and refreshed regularly.
Collapse
|
17
|
Fagnot I, Ye C, Desouza KC. Unpacking Complexities of Mega-Scale Public Sector Information Technology Projects: An Ecosystem Perspective. ACTA ACUST UNITED AC 2018. [DOI: 10.3917/sim.182.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
18
|
Eleftheriou I, Embury SM, Moden R, Dobinson P, Brass A. Data journeys: Identifying social and technical barriers to data movement in large, complex organisations. J Biomed Inform 2017; 78:102-122. [PMID: 29223464 DOI: 10.1016/j.jbi.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/13/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022]
Abstract
Managers in complex organisations often have to make decisions on whether new software developments are worth undertaking or not. Such decisions are hard to make, especially at an enterprise level. Both costs and risks are regularly underestimated, despite the existence of a plethora of software and systems engineering methodologies aimed at predicting and controlling them. Our objective is to help managers and stakeholders of large, complex organisations (like the National Health Service in the UK) make better informed decisions on the costs and risks of planned new software systems that will reuse or extend their existing information infrastructure. We analysed case studies describing new software developments undertaken by providers of health care services in the UK, looking for common points of risk and high cost. The results highlighted the movement of data within and between organisations as a key factor. Data movement can be hindered by numerous technical barriers, but also by other challenges arising from social aspects of the organisation. These latter aspects are often harder to predict, and are ignored by many of the more common software engineering methodologies. In this paper, we propose data journey modelling, a new method aiming to predict places of high cost and risk when existing data needs to move to a new development. The method is lightweight and combines technical and social aspects, but relies only on information that is likely to be already known to key stakeholders, or will be cheap to acquire. To assess the effectiveness of our method, we conducted a retrospective evaluation in an NHS Foundation Trust hospital. Using the method, we were able to predict most of the points of high cost/risk that the hospital staff had identified, along with several other possible directions that the staff did not identify for themselves, but agreed could be promising.
Collapse
Affiliation(s)
- Iliada Eleftheriou
- School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester M13 9PL, UK.
| | - Suzanne M Embury
- School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester M13 9PL, UK.
| | - Rebecca Moden
- Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton BL4 0JR, UK.
| | - Peter Dobinson
- Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton BL4 0JR, UK.
| | - Andrew Brass
- School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester M13 9PL, UK.
| |
Collapse
|
19
|
Car J, Tan WS, Huang Z, Sloot P, Franklin BD. eHealth in the future of medications management: personalisation, monitoring and adherence. BMC Med 2017; 15:73. [PMID: 28376771 PMCID: PMC5381075 DOI: 10.1186/s12916-017-0838-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/16/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Globally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. DISCUSSION eHealth offers opportunities to transform every step of the patient's medicines management journey. From booking appointments, consultation with a healthcare professional, decision-making, medication dispensing, carer support, information acquisition and monitoring, to learning about medicines and their management in daily life. It has the potential to support personalisation and monitoring and thus lead to better adherence. For some of these dimensions, such as supporting decision-making and providing reminders and prompts, evidence is stronger, but for many others more rigorous research is urgently needed. CONCLUSIONS Given the potential benefits and barriers to eHealth in medicines management, a fine balance needs to be established between evidence-based integration of technologies and constructive experimentation that could lead to a game-changing breakthrough. A concerted, transdisciplinary approach adapted to different contexts, including low- and middle-income contries is required to realise the benefits of eHealth at scale.
Collapse
Affiliation(s)
- Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 3 Fusionopolis Link, #06-13, Nexus@One-North, South tower, Singapore, 138543 Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Woan Shin Tan
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 3 Fusionopolis Link, #06-13, Nexus@One-North, South tower, Singapore, 138543 Singapore
- Nanyang Institute of Technology in Health and Medicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
| | - Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 3 Fusionopolis Link, #06-13, Nexus@One-North, South tower, Singapore, 138543 Singapore
- Nanyang Institute of Technology in Health and Medicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Peter Sloot
- Computational Science Laboratory, University of Amsterdam, Amsterdam, The Netherlands
- ITMO University, Saint Petersburg, Russia
- Complexity Institute, Nanyang Technological University, Singapore, Singapore
| | - Bryony Dean Franklin
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
20
|
Clarke A, Watt I, Sheard L, Wright J, Adamson J. Implementing electronic records in NHS secondary care organizations in England: policy and progress since 1998. Br Med Bull 2017; 121:95-106. [PMID: 28043952 DOI: 10.1093/bmb/ldw055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/01/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND A number of different policies have aimed to introduce electronic records into National Health Service (NHS) secondary care organizations in England over recent years. There has been little formal attempt to explore the overall impact of these policies (as opposed to evaluations of individual initiatives) and how they have developed and progressed over time. SOURCES OF DATA National NHS IT policy documents and evaluations of national NHS IT policy between 1998 and 2015. AREAS OF AGREEMENT There has been limited progress in implementing integrated electronic records in secondary organizations since 1998. AREAS OF CONTROVERSY The management and execution of NHS IT policy has been poor, with over ambitious aims contributing to the limited success. GROWING POINTS Detailed guidance on how to implement electronic records in secondary care organizations is required. The ambitions of current policy should be revisited. AREAS TIMELY FOR DEVELOPING FURTHER RESEARCH Research exploring the costs and benefits of different approaches to introducing electronic records is needed.
Collapse
Affiliation(s)
- Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Ian Watt
- Department of Health Sciences, Faculty of Science, University of York, Area 4 Seebohm Rowntree Building, York, YO10 5DD, UK
| | - Laura Sheard
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - John Wright
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Joy Adamson
- Department of Health Sciences, Faculty of Science, University of York, Area 4 Seebohm Rowntree Building, York, YO10 5DD, UK.,Institute of Health and Society, University of Newcastle, NE2 4AX, UK
| |
Collapse
|
21
|
Naughton B, Roberts L, Dopson S, Chapman S, Brindley D. Effectiveness of medicines authentication technology to detect counterfeit, recalled and expired medicines: a two-stage quantitative secondary care study. BMJ Open 2016; 6:e013837. [PMID: 27940634 PMCID: PMC5168655 DOI: 10.1136/bmjopen-2016-013837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the authentication and detection rate of serialised medicines using medicines authentication technology. DESIGN AND INTERVENTION 4192 serialised medicines were entered into a hospital dispensary over two separate 8-week stages in 2015. Medicines were authenticated using secure external database cross-checking, triggered by the scanning of a two-dimensional data matrix with a unit specific 12-digit serial code. 4% of medicines included were preprogrammed with a message to identify the product as either expired, pack recalled, product recalled or counterfeit. SETTING A site within a large UK National Health Service teaching hospital trust. PARTICIPANTS Accredited checking staff, pharmacists and dispensers in a pharmacy department. PRIMARY OUTCOME MEASURES Authentication and detection rate of counterfeit expired and recalled medicines. RESULTS The operational detection rate of counterfeit, recalled and expired medicines scanned as a combined group was 81.4% (stage 1 (S1)) and 87% (stage 2 (S2)). The technology's technical detection rate (TDR) was 100%; however, not all medicines were scanned and of those that were scanned not all that generated a warning message were quarantined. Owing to an operational authentication rate (OAR) of 66.3% (over both stages), only 31.8% of counterfeit medicines, 58% of recalled drugs and 64% of expired medicines were detected as a proportion of those entered into the study. Response times (RTs) of 152 ms (S1) and 165 ms (S2) were recorded, meeting the falsified medicines directive-mandated 300 ms limit. CONCLUSIONS TDRs and RTs were not a limiting factor in this study. The suboptimal OAR poses significant quality and safety issues with this detection approach. Authentication at the checking stage, however, demonstrated higher OARs. There is a need for further qualitative research to establish the reasons for less than absolute authentication and detection rates in the hospital environment to improve this technology in preparation for the incumbent European Union regulative deadline.
Collapse
Affiliation(s)
- Bernard Naughton
- Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK
- Said Business School, University of Oxford, Oxford, UK
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lindsey Roberts
- Medicines Optimisation Clinical Network, Oxford Academic Health Science Network (AHSN), Oxford, UK
| | - Sue Dopson
- Said Business School, University of Oxford, Oxford, UK
| | - Stephen Chapman
- Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - David Brindley
- Said Business School, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
- The Oxford—UCL Centre for the Advancement of Sustainable Medical Innovation (CASMI), University of Oxford, Oxford, UK
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
- Harvard Stem Cell Institute, Cambridge, Massachusetts, USA
- USCF-Stanford Centre of Excellence in Regulatory Science and Innovation (CERSI), USA
| |
Collapse
|
22
|
Atherton H, Ziebland S. What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare? Digit Health 2016; 2:2055207616675559. [PMID: 29942570 PMCID: PMC6001190 DOI: 10.1177/2055207616675559] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives Communications technologies are variably utilised in healthcare. Policymakers globally have espoused the potential benefits of alternatives to face-to-face consultations, but research is in its infancy. The aim of this essay is to provide thinking tools for policymakers, practitioners and researchers who are involved in planning, implementing and evaluating alternative forms of consultation in primary care. Methods We draw on preparations for a focussed ethnographic study being conducted in eight general practice settings in the UK, knowledge of the literature, qualitative social science and Cochrane reviews. In this essay we consider different types of patients, and also reflect on how the work, practice and professional identities of different members of staff in primary care might be affected. Results Elements of practice are inevitably lost when consultations are no longer face-to-face, and we know little about the impact on core aspects of the primary care relationship. Resistance to change is normal and concerns about the introduction of alternative methods of consultation are often expressed using proxy reasons; for example, concerns about patient safety. Any planning or research in the field of new technologies should be attuned to the potential for unintended consequences. Conclusions Implementation of alternatives to the face-to-face consultation is more likely to succeed if approached as co-designed initiatives that start with the least controversial and most promising changes for the practice. Researchers and evaluators should explore actual experiences of the different consultation types amongst patients and the primary care team rather than hypothetical perspectives.
Collapse
Affiliation(s)
- Helen Atherton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Oxford, UK
| |
Collapse
|
23
|
Abstract
This paper discusses the UK’s National Programme for IT (NPfIT), which was an ambitious programme launched in 2002 with an initial budget of some £6.2 billion. It attempted to implement a top-down digitization of healthcare in England’s National Health Service (NHS). The core aim of the NPfIT was to bring the NHS’ use of information technology into the 21st century, through the introduction of an integrated electronic patient record systems, and reforming the way that the NHS uses information, and hence to improve services and the quality of patient care. The initiative was not trusted by doctors and appeared to have no impact on patient safety. The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations. The NPfIT was officially dismantled in September 2011. Deemed the world’s largest civil IT programme, its failure and ultimate demise sparked a lot of interest as to the reasons why. This paper summarises the underlying causes that lead to dismantling the NPfIT. At the forefront of those circumstances were the lack of adequate end user engagement, the absence of a phased change management approach, and underestimating the scale of the project.
Collapse
Affiliation(s)
- Taghreed Justinia
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
24
|
Sligo J, Gauld R, Roberts V, Villa L. A literature review for large-scale health information system project planning, implementation and evaluation. Int J Med Inform 2016; 97:86-97. [PMID: 27919399 DOI: 10.1016/j.ijmedinf.2016.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS.
Collapse
Affiliation(s)
- Judith Sligo
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Robin Gauld
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Vaughan Roberts
- Healthy Together 2020 Technology Programme, Counties Manukau Health, New Zealand
| | - Luis Villa
- Research and Evaluation Office, Health Intelligence and Informatics, Ko Awatea, New Zealand
| |
Collapse
|
25
|
Harrop N, Wood-Harper T, Gillies A. Neglected user perspectives in the design of an online hospital bed-state system: implications for the National Programme for IT in the NHS. Health Informatics J 2016; 12:293-303. [PMID: 17093000 DOI: 10.1177/1460458206069759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Technical aspects of the National Programme for IT in the National Health Service have run ahead of genuine engagement with front-line users. We have explored with front-line NHS staff the factors which limit their contribution to management information from operational systems. Staff place psychological distance between ‘the real job’ and the reporting of information. Even where accurate reporting is heavily incentivized, and operational control is shared between staff and shift leader, the reporting of information to the computer represents a division between caregiving and computer input, and between information openly declared and that waiting to be disclosed. The Programme needs to reconsider how clinicians are to be engaged. Equally, information systems designers, if they expect to obtain management information and want to understand the limitations of that process, need to be socialized into the fields where systems are to be deployed.
Collapse
|
26
|
Mozaffar H, Cresswell KM, Lee L, Williams R, Sheikh A. Taxonomy of delays in the implementation of hospital computerized physician order entry and clinical decision support systems for prescribing: a longitudinal qualitative study. BMC Med Inform Decis Mak 2016; 16:25. [PMID: 26911288 PMCID: PMC4766744 DOI: 10.1186/s12911-016-0263-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. METHODS We undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U.K. We used a combination of semi-structured interviews from six case study sites and two whole day expert roundtable discussions to collect data. Interviews were carried out with users, implementers and suppliers of CPOE/CDS systems. We used thematic analysis to examine the results, drawing on perspectives surrounding the biography of artefacts. RESULTS We identified 15 major factors contributing to delays in implementation of CPOE and CDS systems. These were then categorized in a two-by-two delay classification matrix: one axis distinguishing tactical versus unintended causes of delay, and the second axis illustrating internal i.e., (the adopting hospital) versus external (i.e., suppliers, other hospitals, policymakers) related causes. CONCLUSIONS Our taxonomy of delays in HIT implementation should enable system developers, implementers and policymakers to better plan and manage future implementations. More detailed planning at the outset, considering long-term strategies, sustained user engagement, and phased implementation approaches appeared to reduce the risks of delays. It should however be noted that whilst some delays are likely to be preventable, other delays cannot be easily avoided and taking steps to minimize these may negatively affect the longer-term use of the system.
Collapse
Affiliation(s)
- Hajar Mozaffar
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Kathrin M Cresswell
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Lisa Lee
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway number 3, Teviot Place, Edinburgh, EH8 9AG, UK
| | | |
Collapse
|
27
|
Cranfield S, Hendy J, Reeves B, Hutchings A, Collin S, Fulop N. Investigating healthcare IT innovations: a “conceptual blending” approach. J Health Organ Manag 2015; 29:1131-48. [DOI: 10.1108/jhom-08-2015-0121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).
Design/methodology/approach
– To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.
Findings
– Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.
Practical implications
– Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.
Originality/value
– The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.
Collapse
|
28
|
Cresswell KM, Lee L, Slee A, Coleman J, Bates DW, Sheikh A. Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals. BMJ Open 2015; 5:e008313. [PMID: 26503385 PMCID: PMC4636661 DOI: 10.1136/bmjopen-2015-008313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. SETTING Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. PARTICIPANTS Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. RESULTS Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals' inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. CONCLUSIONS Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications.
Collapse
Affiliation(s)
- Kathrin M Cresswell
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Lisa Lee
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Ann Slee
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Jamie Coleman
- Department of Medical Science and Medical Education, School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, UK
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
29
|
Lee L, Williams R, Sheikh A. How does joint procurement affect the design, customisation and usability of a hospital ePrescribing system? Health Informatics J 2015; 22:828-838. [PMID: 26261217 DOI: 10.1177/1460458215592915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to explore the effect of the joint procurement model adopted during the English National Programme for Information Technology (NPfIT) on the customisation, design and usability of a hospital ePrescribing system. Drawing on qualitative data collected at two case study sites deploying an ePrescribing system jointly procured within one of the NPfIT's geographical clusters, we explain how procurement decisions, difficult relationships with the supplier and strict contractual arrangements contributed to usability issues and difficulties in the customisation process. While some limited change requests made by users were taken up by the developers, these were seen by users as insufficient to meet local clinical needs and practices. A joint procurement approach, such as the NPfIT, thus limited the opportunity and scope of the changes to the ePrescribing system, which impinged not only on the perceived success of the implementation but also on the system's usability.
Collapse
|
30
|
Hao WR, Hsu YH, Chen KC, Li HC, Iqbal U, Nguyen PA, Huang CW, Yang HC, Lee P, Li MH, Hlatshwayo SL, Li YCJ, Jian WS. LabPush: a pilot study of providing remote clinics with laboratory results via short message service (SMS) in Swaziland, Africa - a qualitative study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 118:77-83. [PMID: 25453385 DOI: 10.1016/j.cmpb.2014.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/03/2014] [Accepted: 10/09/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Developing countries are confronting a steady growth in the prevalence of the infectious diseases. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. Although labs usually able to accomplish the requested blood test and produce the results within two days after receiving the samples, but the time for the results to be delivered back to clinics is quite variable depending on how often the motorbike transport makes trips between the clinic and the lab. OBJECTIVE In this study, we seek to assess factors facilitating as well as factors hindering the adoption of mobile devices in the Swazi healthcare through evaluating the end-users of the LabPush system. METHODS A qualitative study with semi-structured and in-depth one on one interviews were conducted over two month period July-August 2012. Purposive sampling was used; participants were those operating and using the LabPush system at the remote clinics, at the national laboratory and the supervisors of users at Swaziland. Interview questions were focused on perceived of ease of use and usefulness of the system. All interviews were recorded and then transcribed. RESULTS This study had aimed its primary focus on reducing TAT, prompt patient care, reducing bouncing of patients and defaulting of patients which were challenges that the clinicians have always had. Therefore, the results revealed several barriers and facilitators to the adoption of mobile device by healthcare providers in the Swaziland. The themes Shortens TAT, Technical support, Patient-centered care, Mindset, Improved communication, Missing Reports, Workload, Workflow, Security of smart phone, Human error and Ownership are sorted by facilitators to barriers. CONCLUSION Thus the end-users perspective, prompt patient care, reduced bouncing of patients, technical support, better communication, willing participant and social influence were facilitators of the adoption m-health in the Swazi healthcare.
Collapse
Affiliation(s)
- Wen-Rui Hao
- Department of Cardiovascular Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan.
| | - Yi-Hsin Hsu
- School of Health Care Administration, Taipei Medical University, Taiwan.
| | - Kuan-Chen Chen
- School of Health Care Administration, Taipei Medical University, Taiwan.
| | - Hsien-Chang Li
- School of Health Care Administration, Taipei Medical University, Taiwan.
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
| | - Phung-Anh Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
| | - Chih-Wei Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Institute of Biomedical Informatics, National Yang Ming University, Taiwan.
| | - Peisan Lee
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Institute of Biomedical Informatics, National Yang Ming University, Taiwan.
| | - Mei-Hsuan Li
- Office of Research and Development, Taipei Medical University, Taiwan.
| | | | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan.
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taiwan.
| |
Collapse
|
31
|
Electronic health record acceptance by physicians: Testing an integrated theoretical model. J Biomed Inform 2014; 48:17-27. [DOI: 10.1016/j.jbi.2013.10.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 08/05/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022]
|
32
|
Penaloza-Ramos MC, Sheppard JP, Jowett S, Barton P, Mant J, Quinn T, Mellor RM, Sims D, Sandler D, McManus RJ, Carr P, Greenfield S, Helliwell B, Nand C, Phillips N, Scott R, Singh S, Ward M. Cost-Effectiveness of Optimizing Acute Stroke Care Services for Thrombolysis. Stroke 2014; 45:553-62. [DOI: 10.1161/strokeaha.113.003216] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Cristina Penaloza-Ramos
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - James P. Sheppard
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Sue Jowett
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Pelham Barton
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Jonathan Mant
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Tom Quinn
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Ruth M. Mellor
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Don Sims
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - David Sandler
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | - Richard J. McManus
- From the Health Economics Unit (M.C.P.-R., S.J., P.B.) and Primary Care Clinical Sciences (J.P.S., R.M.M.), University of Birmingham, Edgbaston, Birmingham, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (J.P.S., R.J.M.); Primary Care Unit, University of Cambridge, Cambridge, UK (J.M.); Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK (T.Q.); University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (D. Sims); and Heart of
| | | | | | | | | | | | | | - Satinder Singh
- Primary Care Clinical Sciences, University of Birmingham
| | | | | |
Collapse
|
33
|
Hyppönen H, Saranto K, Vuokko R, Mäkelä-Bengs P, Doupi P, Lindqvist M, Mäkelä M. Impacts of structuring the electronic health record: a systematic review protocol and results of previous reviews. Int J Med Inform 2013; 83:159-69. [PMID: 24374018 DOI: 10.1016/j.ijmedinf.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper (1) presents the protocol of an on-going systematic literature review on the methods of structuring electronic health record (EHR) data and studying the impacts of implemented structures, thus laying basis for the analysis of the empirical articles (2) describes previous reviews published on the subject and retrieved during the search of bibliographic databases, and (3) presents a summary of the results of previous reviews. METHODS Cochrane instructions were exploited to outline the review protocol - phases and search elements. Test searches were conducted to refine the search. The abstracts and/or full texts of review papers captured by the search were read by two of the team members independently, with disagreements first negotiated between them and if necessary eventually resolved in the team meetings. Additional review articles were picked from the reference lists of the reviews included in our search results. The elements defined in the search strategy and analytic framework were converted to a data extraction tool, which was tested by extracting data from the reviews captured by the search. Descriptive analysis of the extracted data was conducted. RESULTS The 12-stage review protocol that we developed includes definition of the problem, the search strategy and search terms, testing the strategy, conducting the search, updating search from references found, removing duplicates, defining the inclusion and exclusion criteria, exclusion and inclusion of papers, definition of the analytic framework to extract data, extracting data and reporting results. Our searches in fifteen electronic bibliographic databases retrieved 27 reviews, of which 14 were included for full text analysis. Of these, 11 focused on medical and three on nursing record structures. The data structures included forms, ontologies, classifications and terminologies. Some evidence was found on data structure impact on information quality, process quality and efficiency, but not on patients or professionals. CONCLUSIONS The 12 step review protocol resulted in a variety of reviews of different ways to structure EHR data. None of them compared outcomes of different structuring methods; all had a narrower definition of the Intervention (a specific EHR structure) and Outcome (a specific impact category). Several reviews missed a clear connection between the data structures (interventions) and outcomes, indicating that the methods and applications for structuring patient data have rarely been viewed as independent variables. The review protocol should be defined in a manner that allows replication of the review. There are different ways of structuring patient data with varying impacts, which should be distinguished in further empirical studies, as well as reviews.
Collapse
Affiliation(s)
- Hannele Hyppönen
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland.
| | | | - Riikka Vuokko
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Päivi Mäkelä-Bengs
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Persephone Doupi
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Minna Lindqvist
- Institute for Health and Welfare (THL), Department of Information, PB 30, 00271 Helsinki, Finland
| | - Marjukka Mäkelä
- Institute for Health and Welfare (THL), Service System Department, Finland
| |
Collapse
|
34
|
Segar J, Rogers A, Salisbury C, Thomas C. Roles and identities in transition: boundaries of work and inter-professional relationships at the interface between telehealth and primary care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:606-613. [PMID: 23656381 DOI: 10.1111/hsc.12047] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 06/02/2023]
Abstract
Shifting the balance of care towards home and community is viewed as requiring interventions which enhance or complement primary care. Technology-based interventions are seen as key to the future in this work. Telehealthcare implicates a new agenda for inter-professional working across boundaries of healthcare. One such interface is between telehealthcare professionals and professionals located in primary care. This study reports the findings from a qualitative study forming part of a broader project examining the potential of developing and implementing telehealth interventions to support patients with long-term conditions. Semi-structured interviews were undertaken with telehealth nurse care managers, practice nurses and general practitioners in their respective work settings (39 interviews with 62 participants). Observation was undertaken at a telehealth call centre. The research took place between April 2010 and March 2011. Thematic analysis of qualitative data was undertaken. Telehealth nurse care managers' interviews suggested narrative constructions of new roles and identities to fit telehealth work, combining a holistic ideal and retro-appeal with 'traditional' values of nursing, which distinguished and distanced them from counterparts in general practices. Practice nurses and general practitioners were ambivalent and often sceptical about the contribution of telehealth to long-term condition work. Practice nurses' accounts suggested a sense of protectiveness about maintaining boundaries around established remits of managing long-term conditions; general practitioners, having devolved much of the care of long-term conditions to nurses, were keen to retain their positions as gatekeepers to resources. Perceptions of shifts of professional roles, new ways of working and how they are valued form a relevant contextual element to the introduction of telehealth interventions. A pre-emptive view and response to how professionals understand and approach increasingly complex and multi-faceted roles within primary care is likely to prepare and facilitate the introduction and integration of telehealth innovations into existing patient services.
Collapse
|
35
|
Vedel I, Akhlaghpour S, Vaghefi I, Bergman H, Lapointe L. Health information technologies in geriatrics and gerontology: a mixed systematic review. J Am Med Inform Assoc 2013; 20:1109-19. [PMID: 23666776 PMCID: PMC3822120 DOI: 10.1136/amiajnl-2013-001705] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To review, categorize, and synthesize findings from the literature about the application of health information technologies in geriatrics and gerontology (GGHIT). MATERIALS AND METHODS This mixed-method systematic review is based on a comprehensive search of Medline, Embase, PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two researchers and were followed by a narrative synthesis. To move beyond a simple description of the technologies, we employed and adapted the diffusion of innovation theory (DOI). RESULTS 112 papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies (representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-based packages for patients and/or family caregivers; and (5) assistive information technologies. On aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes. Although less frequently studied, positive impacts were found on patients' health, productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients' empowerment. DISCUSSION Further efforts should focus on improving the characteristics of such technologies in terms of compatibility and simplicity. Implementation strategies also should be improved as trialability and observability are insufficient. CONCLUSIONS Our results will help organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented for the care of older adults.
Collapse
Affiliation(s)
- Isabelle Vedel
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Saeed Akhlaghpour
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
- Middlesex University Business School, Middlesex University, London, UK
| | - Isaac Vaghefi
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
| | - Liette Lapointe
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
36
|
White J, Carolan-Rees G. Current state of medical device nomenclature and taxonomy systems in the UK: spotlight on GMDN and SNOMED CT. JRSM SHORT REPORTS 2013; 4:1-7. [PMID: 23885299 PMCID: PMC3704061 DOI: 10.1177/2042533313483719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A standardised terminology for describing medical devices can enable safe and unambiguous exchange of information. Proposed changes to EU-wide medical devices regulations mandate the use of such a system. This article reviews two important classification systems for medical devices in the UK. The Global Medical Device Nomenclature (GMDN) provides a classification system specifically for medical devices and diagnostics, and facilitates data exchange between manufacturers and regulators. SNOMED CT is the terminology of choice in the NHS for communicating, sharing and storing information about patients’ healthcare episodes. Harmonisation of GMDN and SNOMED CT will encourage use of single terminology throughout the lifetime of a device; from regulatory approval through clinical use and post-marketing surveillance. Manufacturers will be required to register medical devices with a European device database (Eudamed) and to fit certain devices with a Unique Device Identifier; both are efforts to improve transparency and traceability of medical devices. Successful implementation of these elements depends on having a consistent nomenclature for medical devices.
Collapse
Affiliation(s)
- Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK
| | | |
Collapse
|
37
|
Cresswell KM, Bates DW, Sheikh A. Ten key considerations for the successful implementation and adoption of large-scale health information technology. J Am Med Inform Assoc 2013; 20:e9-e13. [PMID: 23599226 PMCID: PMC3715363 DOI: 10.1136/amiajnl-2013-001684] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/04/2013] [Accepted: 04/01/2013] [Indexed: 01/18/2023] Open
Abstract
The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians.
Collapse
Affiliation(s)
- Kathrin M Cresswell
- The School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.
| | | | | |
Collapse
|
38
|
Zinszer K, Tamblyn R, Bates DW, Buckeridge DL. A qualitative study of health information technology in the Canadian public health system. BMC Public Health 2013; 13:509. [PMID: 23705692 PMCID: PMC3665446 DOI: 10.1186/1471-2458-13-509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 05/16/2013] [Indexed: 11/18/2022] Open
Abstract
Background Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. Methods A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Results Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. Conclusions The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy.
Collapse
Affiliation(s)
- Kate Zinszer
- Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, QC H3A 1A3, Canada
| | | | | | | |
Collapse
|
39
|
Palmier-Claus JE, Rogers A, Ainsworth J, Machin M, Barrowclough C, Laverty L, Barkus E, Kapur S, Wykes T, Lewis SW. Integrating mobile-phone based assessment for psychosis into people's everyday lives and clinical care: a qualitative study. BMC Psychiatry 2013; 13:34. [PMID: 23343329 PMCID: PMC3562160 DOI: 10.1186/1471-244x-13-34] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/02/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients' perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. METHOD 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants' perceptions and experiences of the devices, and thematic analysis was used to analyse the data. RESULTS Three themes emerged from the data: i) the appeal of usability and familiarity, ii) acceptability, validity and integration into domestic routines, and iii) perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. CONCLUSIONS The feedback presented in this paper suggests that patients are conscious of the benefits that mobile-phone based assessment could bring to clinical care, and that the technology can be successfully integrated into everyday routine. However, it also suggests that it is important to demonstrate to patients the personal, as well as theoretical, benefits of the technology. In the future it will be important to establish whether clinical practitioners are able to use this technology as part of a personalised mental health regime.
Collapse
Affiliation(s)
- Jasper E Palmier-Claus
- Division of Clinical Psychology, School of Psychological Sciences, the University of Manchester, Oxford Road, Manchester, United Kingdom.
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - John Ainsworth
- Institute of Population Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Matt Machin
- Institute of Population Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Christine Barrowclough
- Division of Clinical Psychology, School of Psychological Sciences, the University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Louise Laverty
- Department of Sociology, Social Policy and Criminology, the University of Liverpool, Liverpool, United Kingdom
| | - Emma Barkus
- School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, Australia
| | - Shitij Kapur
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, the University of Manchester, Oxford Road, Manchester, United Kingdom
| |
Collapse
|
40
|
Cresswell K, Coleman J, Slee A, Williams R, Sheikh A. Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals: a questionnaire study. PLoS One 2013; 8:e53369. [PMID: 23335961 PMCID: PMC3546047 DOI: 10.1371/journal.pone.0053369] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned. METHODS A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated. RESULTS We obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity. CONCLUSIONS Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activities.
Collapse
Affiliation(s)
- Kathrin Cresswell
- The School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom.
| | | | | | | | | |
Collapse
|
41
|
Cresswell KM, Worth A, Sheikh A. Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation. Health Informatics J 2012; 18:251-70. [PMID: 23257056 DOI: 10.1177/1460458212445399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of electronic health records (EHRs) lies at the heart of many international efforts to improve the safety and quality of healthcare. England has attempted to introduce nationally procured EHR software--the first country in the world to do so. In this qualitative comparative case study tracing local developments over time we sought to generate a detailed picture of the implementation landscape characterising this first attempt at implementing nationally procured software through studying three purposefully selected hospitals. Despite differences in relation to demographic considerations and local implementation strategies, implementing hospitals faced similar technical and political challenges. These were coped with differently by the various organisations and individual stakeholders, their responses being shaped by contextual contingencies. We conclude that national implementation efforts need to allow effective technology adoption to occur locally before considering larger-scale interoperability. This should involve the allocation of sufficient time for individual users and organisations to adjust to the complex changes that often accompany such service re-design initiatives.
Collapse
|
42
|
Institutional Isomorphism and Change: The National Programme for IT – 10 Years On. JOURNAL OF INFORMATION TECHNOLOGY 2012. [DOI: 10.1057/jit.2012.18] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Institutional isomorphism has been a major intellectual contribution within institutional theory for three decades. The effects and processes of institutionalization have traditionally focused on stability and persistence of institutions, and more recently on institutional change. This study contributes to the IS field using the lens of coercive, mimetic and normative isomorphism and change within a highly institutionalized organizational field of health care. The setting is the National Health Service in the United Kingdom, where in 2002 a major government policy was launched to introduce Electronic Health Records (EHRs) to over 50 million citizens. Using episodic interviewing techniques and content analysis of government health IT policy documents, this study provides a longitudinal analysis of the introduction of government policy to modernize health care using information technology. Institutional isomorphic conditions become conflicted with attempts to impose field and organizational change. As clinicians attempt to retain their professional dominance in a climate of almost continuous restructuring of health services, political initiatives to implement EHRs are met with resistance from key stakeholders, resulting in policy changes and further delayed implementation times.
Collapse
|
43
|
Olson JR, Belohlav JA, Cook LS. A Rasch model analysis of technology usage in Minnesota hospitals. Int J Med Inform 2012; 81:527-38. [DOI: 10.1016/j.ijmedinf.2012.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 01/08/2012] [Accepted: 01/23/2012] [Indexed: 11/26/2022]
|
44
|
Hung WH, Chang LM, Lee MH. Factors Influencing the Success of National Healthcare Services Information Systems. JOURNAL OF GLOBAL INFORMATION MANAGEMENT 2012. [DOI: 10.4018/jgim.2012070104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By extending the updated D&M IS success model, this study examines the multi-dimensional aspects to identify influential factors and construct a suitable model for explaining NHSS success in Taiwan. Through the empirical results from the perspective of 1215 public healthcare workers, this study has arrived at several findings. First, eight salient factors were found which influenced NHSS success from the dimensions of user characteristics, organizational context, and system characteristics. Second, the factors of user experience, user training, information quality, service quality, and user satisfaction have a strong positive effect on system use, whereas user attitude and facilitating conditions have a significant and negative effect. Further, user attitude, user training, top management support, system quality, information quality, and service quality are also significantly correlated to user satisfaction. The results of this study can assist governments in other countries in developing more effective NHSS and better e-Government practices.
Collapse
Affiliation(s)
- Wei-Hsi Hung
- National Chung Cheng University, Advanced Institute of Manufacturing with High-tech Innovations (AIM-HI), Taiwan
| | | | | |
Collapse
|
45
|
Physicians' views and assessments on picture archiving and communication systems (PACS) in two Turkish public hospitals. J Med Syst 2012; 36:3555-62. [PMID: 22392563 DOI: 10.1007/s10916-012-9831-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/05/2012] [Indexed: 10/28/2022]
Abstract
A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.
Collapse
|
46
|
|
47
|
Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V, Petrakaki D, Crowe S, Marsden K, Robertson A, Morrison Z, Klecun E, Prescott R, Quinn C, Jani Y, Ficociello M, Voutsina K, Paton J, Fernando B, Jacklin A, Cresswell K. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals. BMJ 2011; 343:d6054. [PMID: 22006942 PMCID: PMC3195310 DOI: 10.1136/bmj.d6054] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the implementation and adoption of the NHS detailed care records service in "early adopter" hospitals in England. DESIGN Theoretically informed, longitudinal qualitative evaluation based on case studies. SETTING 12 "early adopter" NHS acute hospitals and specialist care settings studied over two and a half years. DATA SOURCES Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers' field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. RESULTS Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals. CONCLUSIONS Implementation of the NHS Care Records Service in "early adopter" sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution.
Collapse
Affiliation(s)
- Aziz Sheikh
- eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9DX, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
While A, Dewsbury G. Nursing and information and communication technology (ICT): A discussion of trends and future directions. Int J Nurs Stud 2011; 48:1302-10. [DOI: 10.1016/j.ijnurstu.2011.02.020] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 02/02/2011] [Accepted: 02/25/2011] [Indexed: 11/25/2022]
|
49
|
Kane GC, Labianca G(J. IS Avoidance in Health-Care Groups: A Multilevel Investigation. INFORMATION SYSTEMS RESEARCH 2011. [DOI: 10.1287/isre.1100.0314] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
50
|
Bower P, Cartwright M, Hirani SP, Barlow J, Hendy J, Knapp M, Henderson C, Rogers A, Sanders C, Bardsley M, Steventon A, Fitzpatrick R, Doll H, Newman S. A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial. BMC Health Serv Res 2011; 11:184. [PMID: 21819569 PMCID: PMC3169462 DOI: 10.1186/1472-6963-11-184] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background It is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There is significant interest in the potential for technology to reduce utilisation of health services in these patient populations, including telecare (the remote, automatic and passive monitoring of changes in an individual's condition or lifestyle) and telehealth (the remote exchange of data between a patient and health care professional). The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact. Methods/Design We are conducting a large scale, multi-site study of the implementation, impact and acceptability of these new technologies. A major part of the evaluation is a cluster-randomised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs. The trial involves a number of outcomes, including health care utilisation and quality of life. We describe the broad evaluation and the methods of the cluster randomised trial Discussion If telehealth and telecare technology proves effective, it will provide additional options for health services worldwide to deliver care for populations with high levels of need. Trial Registration Current Controlled Trials ISRCTN43002091
Collapse
Affiliation(s)
- Peter Bower
- Health Sciences Research Group, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|