Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation

Robertson, Ann, Cresswell, Kathrin, Takian, Amirhossein, Petrakaki, Dimitra, Crowe, Sarah, Cornford, Tony ORCID: 0000-0001-9202-1498, Barber, Nicholas, Avery, Anthony, Fernando, Bernard, Jacklin, Ann, Prescott, Robin, Klecun, Ela ORCID: 0000-0002-0329-1566, Paton, James, Lichtner, Valentina, Quinn, Casey, Ali, Maryam, Morrison, Zoe, Jani, Yogini, Waring, Justin, Marsden, Kate and Sheikh, Aziz (2010) Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. British Medical Journal, 341 (4564). pp. 1-12. ISSN 0959-8138

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Abstract

Objectives: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. Design: A mixed methods, longitudinal, multisite, socio-technical case study. Setting: Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete. Data sources and analysis: Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data. Main results: Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities. Conclusions: Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations’ perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems.

Item Type:	Article
Official URL:	http://www.bmj.com/
Additional Information:	© 2010 BMJ Publishing. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
Divisions:	Management LSE Health
Subjects:	R Medicine > RA Public aspects of medicine
Date Deposited:	06 Sep 2010 11:00
Last Modified:	11 Dec 2024 23:41
URI:	http://eprints.lse.ac.uk/id/eprint/29230

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