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

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, sociotechnical 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 sociotechnical 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 topdown, 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.

Hybridity as a process of technology's ‘translation’: Customizing a national Electronic Patient Record

“…The findings we present here are part of a larger study of the evaluation of the NCRS implementation in the NHS in England (Klecun et al, 2014;Robertson et al, 2010;Sheikh et al, 2011;Takian et al, 2012), which was launched in 2002 by the Department of Health (DH). The NCRS was envisaged as an electronic patient record to be shared across hospitals in the English NHS (DH, 2006).…”

Anything but engaged: user involvement in the context of a national electronic health record implementation

“…28,30,31 In doing so, we focused on the implementation of Lorenzo as a complex type of EHR software that was intended to be co-created in collaboration with NHS staff, and which therefore did not exist in its final form when implementation began.…”

“…The NHS CRS has been conceptualised as a 'top-down' implementation, this reflecting its central management, substantial scale and ambitious implementation timelines. 28,29 NHS Connecting for Health (NHS CFH), an 'arms-length' government agency, was charged in 2005 with implementing these nationally procured EHR systems. These included iSOFT's Lorenzo Regional Care (henceforth referred to as Lorenzo), Cerner's Millennium and CSE Healthcare's RiO.…”

Enseñanza de un Programa de Ortesis Mental Clínica: Experiencia con Estudiantes de Medicina en Uruguay

“…Los clínicos pueden tener el beneficio de ver todo bajo la forma de una misma HCE cuando los diferentes efectores de saludé operan bajo estándares de interoperabilidad, como los que emana el programa SALUD.UY. Algunos de los beneficios del uso de una HCE interoperable son los tiempos de espera menores para la atención, la disminución de los errores médicos, la facilidad de investigación y grandes ahorros [3].…”

“…Los clínicos pueden tener el beneficio de ver todo bajo la forma de una misma HCE cuando los diferentes efectores de saludé operan bajo estándares de interoperabilidad, como los que emana el programa SALUD.UY. Algunos de los beneficios del uso de una HCE interoperable son los tiempos de espera menores para la atención, la disminución de los errores médicos, la facilidad de investigación y grandes ahorros [3].A pesar de que la HCE ha mostrado ser una forma eficiente y segura para mejorar la calidad de la atención médica, su adopción enfrenta todavía resistencia al cambio por parte de algunos profesionales de la salud. Se describe la percepción poco amigable de sistemas, la falta de preparación técnica y la curva de aprendizaje resulta prolongada en la capacitación y en su uso diario [1].…”