Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust

Abstract

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.

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland

“…13 In addition, continuing professional development for practice managers has been recommended, 14 and in this case could ensure that managers felt supported, engaged and confident in the introduction of new patient consultation and communication technologies within their practices.…”

“…6,7 They have also been shown to be influential in the development of practice policies, 8 particularly in relation to issues of patient access. 9,10 Whilst practice managers in Scotland have been surveyed in relation to general information technology (IT) use 11 and access to NHSnet, 12 and practice managers in England have been included in a qualitative study of primary care staff attitudes to eHealth in general, 13 to our knowledge no previous UK studies have systematically surveyed or collected in-depth qualitative data from practice managers about their views on the use of non-face-to-face consultation/ communication technologies in their practices. This mixed-methods study therefore aimed to explore practice managers' views on routine information and communication technology-mediated patient contact in the context of the local situation within which they work, and their potential role in the introduction and normalisation of non-face-to-face consultation/communication technologies within their practices.…”

SNOMED is coming, and more about using and interacting with technology in primary care

“…4 The role of managers as a facilitator or barrier to the use of IT has been little studied and this paper provides valuable insights and builds on previous work suggesting an emergent independence of this professional group. [5][6][7] The second, from Karhula et al, looks at the different ways email is used in primary care. 8 Whilst some findings are less surprising for example: it is hard to make complex decisions by email, some are not read, and how the leaders in primary care prefer this as a medium -others findings are more surprising.…”

Do general practice characteristics influence uptake of an information technology (IT) innovation in primary care?

“…1,2,3 Factors that might influence this variability include local history and culture of adoption, perceptions of the relative benefits and challenges of the new technology compared to existing practice, ease of use, confidentiality and security concerns and the time, training and resources available to ensure effective implementation. Variations between different staff groups have also been observed.…”