Electronic patient information systems and care pathways: The organisational challenges of implementation and integration

Dent, Mike; Tutt, Dylan

doi:10.1177/1460458213518545

Cited by 14 publications

(29 citation statements)

References 26 publications

(44 reference statements)

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“…Frustration with information technology (IT) systems was frequently reported in the UK qualitative literature. 72,94,95,100,102,105,107,110,118,124,126,134,146,149 A lack of compatibility between systems used in different services, such as health and social care or general practices and hospitals, was a key barrier to integrated working. 94,95,102 In one study, 100 over half of the clinicians (56%) reported that they were dissatisfied with IT systems.…”

Section: Information Technology and Logisticsmentioning

confidence: 99%

Understanding new models of integrated care in developed countries: a systematic review

Baxter

Johnson

Chambers

et al. 2018

Health Serv Deliv Res

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BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Information Technology and Logisticsmentioning

confidence: 99%

Understanding new models of integrated care in developed countries: a systematic review

Baxter

Johnson

Chambers

et al. 2018

Health Serv Deliv Res

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“…Some recent studies have focused on the use of these new technologies in order to offer patients with mobility difficulties integrated care by pooling electronic records from patients, caregivers or healthcare teams as well as doctors' follow-ups [82]. However, the implementation of such processes requires considerable organisation and adequate resources [83] and can lead to technical interoperability problems [84].…”

Section: Resultsmentioning

confidence: 99%

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Pinaire

Azé

Bringay

et al. 2017

Health Inf Sci Syst

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Background: Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves.Methods: We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions.Results: Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). Conclusion:This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.

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“…Kommunenes valgfrihet påvirkes også av tidligere teknologiske løsninger. Dette kan forstås som en form for stiavhengighet der tidligere valg påvirker dagens muligheter ved å legge føringer og begrensinger (Dent & Tutt, 2014). Et eksempel på dette er hvordan valg av elektronisk pasientjournalsystem tatt mange år tilbake, i dag legger føringer på hvilke velferdsteknologiske løsninger kommunene kan velge.…”

Section: Sammenkobletunclassified

Tverrfaglig, sammenkoblet og allestedsnærværende– om implementering av velferdsteknologi i kommunale helse- og omsorgstjenester

Lo¹,

Waldahl²,

Antonsen³

2019

Nordisk välfärdsforskning | Nordic Welfare Research

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Municipalities are core welfare agencies in the Nordic countries, and as such have an obligation to supply their own services as well as to implement new technologies. Welfare technologies have in recent years assumed increasing importance in the Nordic countries as an important tool for innovating healthcareas a way to improve quality as well as to achieve better cost efficiency. However, many municipalities have experienced a number of problems when implementing these technologies. In this paper, we investigate the challenges of implementing welfare technologies in municipal healthcare by exploring how the characteristics of welfare technologies cause difficulties for the people working to implement them. The analysis is based on data from four different studies carried out in Norwegian municipalities. We summarize our findings as three aggregated characteristics of welfare technologies (interdisciplinary, interconnected, and ubiquitous). We discuss how these characteristics challenge the implementation of welfare technologies and argue that recognizing and attending to these characteristics is essential for successful implementation.

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Electronic patient information systems and care pathways: The organisational challenges of implementation and integration

Cited by 14 publications

References 26 publications

Understanding new models of integrated care in developed countries: a systematic review

Understanding new models of integrated care in developed countries: a systematic review

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Tverrfaglig, sammenkoblet og allestedsnærværende– om implementering av velferdsteknologi i kommunale helse- og omsorgstjenester

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