Objectives e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes. Design Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers. Subjects Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study. Setting A north London PCT with 62 general practices. Four practices were selected for the study. Results Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care.Conclusions At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice.

Both junior and senior doctors have basic computer literacy, but nearly half of this population identify the use of database software as a training need. In addition, there are several health informatics topics of which a large proportion of doctors, particularly the juniors, have little knowledge, but which have not been identified as training needs. Some recommendations are made for provision of in-house health informatics education for doctors.

This is the second in a series of articles exploring international trends in health science librarianship in the first decade of the 21st century. The invited authors were asked to reflect on developments in their country -viz. Australia, Canada, New Zealand and the United States. Future issues will track trends in Northern Europe, the Nordic countries, Southern Europe and Latin America. JM

In the UK the government is committed to major expenditure on IT infrastructure and systems (electronic records, booking and prescribing)

This is the third in a series of articles exploring international trends in health science librarianship in the first decade of the 21st century. The invited authors were asked to reflect on developments in their country

This paper builds on Leslie Morton's vision of enabling users through education and training. It describes three different approaches to mediated training for medical students and clinicians provided by peers, juniors (i.e. medical students) and information specialists (i.e. clinical librarians) and considers the benefits to the participants. The training was provided either on a one-to-one basis or within teams in their work environments (e.g. offices, wards, team meetings). The first two projects (peer tutoring and reverse mentoring) suggest that contextualized training, using intermediaries, provides the direct benefit of cost-effective IT skill development and the indirect benefits deriving from the interactions between the trainers and the target groups. The third project, the outreach librarian study, provides evidence of both direct benefits (i.e. time saved, quality of service, skills acquired, financial savings and improved evidence-based medicine implementation) and indirect, long-term benefits relating to more social issues (e.g. perceptions of the library, clinical teams, job satisfaction and patient interactions). The general conclusion to emerge from this review of case studies is that the concept of educational benefits is very broad and that empirical studies need to look at both obvious and less obvious benefits.

This article reviews the six papers published so far in this series on global trends in health science librarianship. Starting with a retrospective review of trends in the twentieth-century, the series has covered 6 different regions, with contributions from 21 countries. As this is the half-way point in the survey, it seems a useful point at which to reflect on what has emerged so far. The method of content analysis is used to identify key trends. The top five trends are explored. JMKeywords: health care libraries, health science librarianship, library and information professionals, research, qualitative

This is the last in a series of articles exploring international trends in health science librarianship in the 21st century. The focus of the present issue is Russia. The next feature column will initiate a new series entitled New Directions in Health Science Librarianship. The first contribution will be from Australia. JM.