Using Existing Response Repertoires to Make Sense of Information System Implementation

The implementation of information systems (IS) in organizations often triggers new situations in which users experience a disruption of existing work patterns and routines. Sensemaking becomes central in making users’ meanings explicit, serving as a foundation for further actions and interactions with the new technology. The purpose of this paper is to study how users make sense of new technologies by building on existing response repertoires. Empirically, we present findings from a study of an Electronic Patient Record (EPR) system implementation in two Danish hospital wards. Our findings illustrate: (1) how doctors’ and nurses’ existing routines are disrupted by the new technology, (2) how identity construction plays an important part in the users’ meaning construction process, and (3) how self-fulfilling prophecies are formed as a natural part of their sensemaking. The study contributes to existing literature by providing a detailed account of how users’ early sensemaking of a technology influences their subsequent actions and reactions towards it. Our findings support managers in understanding users’ perceptions of a new technology, helping them in planning and executing the implementation process

A study of general practitioners' perspectives on electronic medical records systems in NHS Scotland

<b>Background</b> Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. <p></p><b> Methods</b> We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. <p></p> <b>Results</b> The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. <b>Conclusion </b>Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors

Applying sense-making to integrated health IT: Renal care in the UK and Sweden

Information technology (IT) in healthcare combines opportunities for improved integrated healthcare delivery with barrierswhich include clinician resistance and low adoption rates. While national level initiatives are taken to promote electronichealthcare (e-health), it is at the grassroots level that their outcomes unfold. This paper employs sense-making theory toextend prior research on the implementation of health IT by investigating the introduction of IT into renal care units in theUK and Sweden. Issues such as management support, user training, usability of systems and perceived benefits of technologywere found to have a direct impact on users’ sense-making processes. The manner in which people make sense of imposedsystems has far reaching effects, as the gap between intended results and actual outcomes is not limited to disparities betweenmicro-level end-users alone, but spans multiple levels including higher authorities, as well as individuals at the grassrootslevel

The multi-disciplinary team members' use of the electronic patient record within one emergency medical asssement unit

This is a qualitative case study of socio-technical work. This study provided a rare example of an in-depth study of an electronic patient record system in (recent) use, in the only site in Wales where this was possible. The study explored the actual use of the Welsh Individual Health Record (IHR) technology by the multi-disciplinary team members working in an emergency medical assessment unit (EMAU). Purposeful sampling was used. Data collection methods were interviews, informal observations and documents. Interviews were audio recorded and transcribed verbatim. Complex Adaptive Systems Theory was used as the lens during data analysis. Three main themes emerged: Managing the dynamic context of the EMAU; Patient safety and Issues with the adoption of the IHR. Clear findings emerged on the usefulness of electronic patient record re: medication safety, bridging the intersection of care, as a vessel for information in the case of patients unable to give their medical histories and facilitating co-production to enhance safe, patient-centred care. The IHR system can mediate the information gaps and should not be developed as static entities but should be allowed to grow and adapt to emergent user requirements

We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in England

In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital

A meta-narrative review of electronic patient records

This session comprises four papers that consider how systematic review methods may be developed in order to make the best use of complex evidence in education and health. The methods and approaches reflected upon in these papers are not drawn from a single research tradition, but share a common goal of broadening the methodological scope of systematic reviews and better understanding the utilisation of knowledge produced in this way. The first paper (Henry Potts) reports an ongoing review using a meta-narrative approach to make sense of the diverse sources of knowledge regarding electronic patient records. The review method has stressed the importance of understanding knowledge from within the research tradition in which it was produced; it is argued that this has important implications for the way that evidence is utilised in the policy making process. The second paper (Geoff Wong) reflects upon the experience of using an explicit realist approach in the synthesis of the evidence in Internet based learning. This realist synthesis offers a method of making sense of the highly heterogeneous and context dependent evidence which exists in this field thus enabling greater insights into what makes such educational interventions ‘work’. The third paper (Rod Sheaff) reports a review of the predominantly qualitative research literature on organisational structures and their impacts upon policy outcomes in health systems. A scoping study found 14389 relevant papers of which 1568 were selected for review. These studies were very variable in the amount and quality of the qualitative data, hence 'evidence', which they reported. The paper describes an attempt to adapt realist methods so as to synthesise such bodies of research in ways which take account of this variation in the strength of qualitative evidence. The fourth paper (Mark Pearson) draws upon the work of Donald Campbell and colleagues in order to gain a fuller understanding of how systematic reviews are utilised in the policy making process. It is argued that interpretive approaches to understanding policy making (such as rhetorical analysis) need to be tempered with a more nuanced understanding of research validity. The case is made that interpretive approaches not only can, but should, be melded with research validity to increase understanding of the policy making process

A strategic approach to making sense of the “wicked” problem of ERM

Purpose – The purpose of this paper is to provide an approach to viewing the “wicked” problem of electronic records management (ERM), using the Cynefin framework, a sense-making tool. It re-conceptualises the ERM challenge by understanding the nature of the people issues. This supports decision making about the most appropriate tactics to adopt to effect positive change. Design/methodology/approach – Cynefin was used to synthesise qualitative data from an empirical research project that investigated strategies and tactics for improving ERM. Findings – ERM may be thought of as a dynamic, complex challenge but, viewed through the Cynefin framework, many issues are not complex; they are simple or complicated and can be addressed using best or good practice. The truly complex issues need a different approach, described as emergent practice. Cynefin provides a different lens through which to view, make sense of and re-perceive the ERM challenge and offers a strategic approach to accelerating change. Research limitations/implications – Since Cynefin has been applied to one data set, the findings are transferrable not generalisable. They, and/or the approach, can be used to further test the propositions. Practical implications – The resultant ERM framework provides a practical example for information and records managers to exploit or use as a starting point to explore the situation in particular organisational contexts. It could also be used in other practical, teaching and/or research-related records contexts. Originality/value – This paper provides a new strategic approach to addressing the wicked problem of ERM, which is applicable for any organisational context

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

Riding the techwave in an era of change

Learn how innovation is finding its way within the healthcare sector and get a grip on the latest technological developments. Based on insights from 77 stakeholders within the Dutch healthcare system, including healthcare professionals, entrepreneurs, researchers, consultants, policy makers, and input from 80 healthcare consumers this book helps you to understand: • the technologies with the highest implementation potential in the healthcare

Evaluation of data usability generated by wearables & IoT-enabled home use medical devices via Telehealth to identify if blockchain can solve potential challenges

The adoption of blockchain shows a variety of benefits owing to an incorruptible digital ledger and a decentralized database. This has eliminated the need for a gatekeeper to oversee all associated transactions. Blockchain, the underlying technology behind bitcoin and other crypto-currencies, has found use in many industries besides finance, such as healthcare, where it has shown promise in several use-cases. Patient data is collected using a plethora of devices, such as wearables or IoT-enabled home use medical devices. These types of devices are utilized in telehealth and provide the ability to remotely monitor the patient’s health condition. This requires the patient to perform measurements themselves in their home (such as vital signs), which puts the burden of reliable and precised patient exam data in the hands of the patients. The purpose of this quantitative study is to increase the understanding of what factors affect data usability generated by these devices, with the findings that the surveyed medical professionals are concerned that patients may have issues setting up the device in the home, operating the device properly (including not positioning themselves or the device correctly), the provider not knowing where the patient resides during measurement, or the patient’s inability to determine when a device has malfunctioned. Upon analyzing blockchain’s capabilities, it was discovered that blockchain cannot fix all identified hurdles, however, it can be used (in conjunction with smart contracts) to limit invalid data transmission to the provider. It was discussed that blockchain may also be utilized to overcome interoperability issues caused by the inability of most Electronic Medical Records (EMRs – sometimes also referred to as Electronic Health Record – EHR) to communicate and provide the patient governance of his/her own medical record. While there are interoperability issues amongst blockchain themselves, Estonia, for instance, has harnessed the power of a single blockchain for digital security and has overcome this interoperability issue