Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

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

The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems

Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter\u27s (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees\u27 concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter\u27s eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients\u27 families and communities through reducing the costs of healthcare

The Mission System: An Electronic Health Record for Medical Treatment in Guatemala

Abstract Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is necessary. Methods: A system development framework was used to help identify the elements necessary for successful EHR workflow development for NHI. Focused interviews were conducted using structured interview guides with questions targeted towards EHR system design from first-hand observation from volunteers and staff members. Results: All the participants agreed that an EHR system would benefit NHI and will provide the ability to monitor patient trends over time, but will need to be simple, and have the ability to use in areas with no Wi-Fi. Implications for Practice: Using the information obtained from the structured interview guides, first-hand observation, aggregate data from NHI, and IT considerations, a set of elements and data were identified, and a series of recommendations established for a more streamlined method of collecting patient data for NHI

Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region

Emergency Physicians\u27 Perspectives on the Usability of Health Information Exchange

Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions? Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south using theoretical sampling and unstructured face-to face interviews. Concepts from the coded segments were developed into categories and an overarching theoretical scheme visualized in a conceptual framework. A substantive theory emerged that using the HIE among emergency physicians is the process of rationalizing non-use and reconciling challenges and benefits. The antecedent of usability was a typical day in the emergency department and why participants accessed the HIE and under what conditions. Six major themes emerged: using the HIE, influencing clinical decisions, struggling with challenges and barriers, recognizing benefits, current views, and rationalizing not using or reduced use of the HIE. Emergency physicians gave good reasons why the HIE is not being used for the majority of patients while reconciling the challenges and benefits of using the HIE to explain the role of HIEs in making clinical decisions. There was a disconnect in the necessity of using the HIE to make clinical decisions and any negative outcomes that may occur in patients from not using the HIE. Generally, emergency physicians viewed the HIE as not being user-friendly and that they probably do not use the HIE as much as they could for making clinical decisions. The perspective of the emergency physicians was the emergency environment is too busy and because the HIE is less than user-friendly as needed by physicians to practice emergency medicine, the HIE disrupts workflow and is a deterrent to consistent usage in making clinical decisions. A better understanding of how emergency physicians decided to use the HIE in making clinical decisions gives insights about how to achieve HIE usability. Satisfied end-users who view the HIE as effective and efficient should use the HIE more. However, this requires removing challenges and barriers while recognizing more benefits to using the HIE, and addressing the underlying reasons for not using the HIE. Understanding the complexities of using the HIE and providing solutions to increase usability of the HIE is necessary to influence greater use of the HIE in clinical decisions with demonstrated positive outcomes for patients

The deferred model of reality for designing and evaluating organisational learning processes: A critical ethnographic case study of Komfo Anokye teaching hospital, Ghana

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The study proposed an evidence-based framework for designing and evaluating organisational learning and knowledge management processes to support continuously improving intentions of organisations such as hospitals. It demarcates the extant approaches to organisational learning including supporting technology into ‘rationalist’ and ‘emergent’ schools which utilise the dichotomy between the traditional healthcare managers’ roles and clinicians’ roles, and maintains that they are exclusively inadequate to accomplish transformative growth intentions, such as continuously improving patient care. The possibility of balancing the two schools for effective organisational learning design is not straightforward, and fails; because the balanced-view school is theoretically orientated and lack practical design to resolve power tensions entrenched in organisational structures. Prior attempts to address the organisational learning and knowledge management design and evaluation problematics in actuality have situated in the interpretivist traditions, only focusing on explanations of meanings. Critically, this is uncritical of power relations and orthodox practices. The theory of deferred action is applied in the context of critical research methods and methodology to expose the motivations behind the established organisational learning and knowledge management practices of Komfo Anokye Teaching Hospital (KATH) which assumed rationality design conceptions. Ethnographic data was obtained and interpreted with combined critical hermeneutics and narrative analyses to question the extent of healthcare learning and knowledge management systems failures and unveil the unheard voices as force for change. The study makes many contributions to knowledge but the key ones are: (i) Practically, the participants accepted the study as a catalyst for (re)-designing healthcare learning and knowledge management systems to typify the acceptance of the theory of deferred action in practice; (ii) theoretically, the cohered emergent transformation (CET) model was developed from the theory of deferred action and validated with empirical data to explain how to plan strategically to achieve transformative growth objectives; and (iii) methodologically, the sense-making of the ethnographic data was explored with the combined critical hermeneutics and critical narrative analyses, the data interpretation lens from the critical theory and qualitative pluralism positions, to elucidate how the unheard emergent voices could bring change to the existing KATH learning and knowledge management processes for improved patient care