A new ERA? Electronic records in ambulances: a research programme.

In order to support the continued shift to out of hospital care, ambulance clinicians need to be able to decide which patients will benefit from being left at home, refer to alternative care providers, and ensure that appropriate patient information is passed on to them. Technology can help in a number of ways. Firstly, apps and referral tools can aid decision-making at the scene. Secondly, technology can facilitate the transfer of patient information to ambulance clinicians at the scene or even before arrival, e.g. by sharing information on past contacts with a GP, or on a DNACPR directive. Thirdly, it can support real time remote sharing of information so that, for example, an ED consultant can advise about the appropriate conveyance and care decisions while the patient is still at home. Fourthly, it can support the easy transfer of patient information to other care providers like GPs. Finally, electronic records can make data more readily available for audit, research and evaluation (Morrison et al., 2014). Data can be used in future research to inform service improvements, as well as providing ambulance services with a valuable store of information to run automated clinical and management reports, as well as defending against medico-legal action

Implementation of electronic patient clinical records in ambulances in the UK: a national survey.

Background: The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances. Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods: We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction. The interviews were transcribed and thematically analysed, by three members of the research team. Results: We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care

Using Blueprints to promote interorganizational knowledge transfer in digital health initiatives—a qualitative exploration of a national change program in English hospitals

OBJECTIVE: The Global Digital Exemplar (GDE) Program is a national attempt to accelerate digital maturity in healthcare providers through promoting knowledge transfer across the English National Health Service (NHS). “Blueprints”—documents capturing implementation experience—were intended to facilitate this knowledge transfer. Here we explore how Blueprints have been conceptualized, produced, and used to promote interorganizational knowledge transfer across the NHS. MATERIALS AND METHODS: We undertook an independent national qualitative evaluation of the GDE Program. This involved collecting data using semistructured interviews with implementation staff and clinical leaders in provider organizations, nonparticipant observation of meetings, and key documents. We also attended a range of national meetings and conferences, interviewed national program managers, and analyzed a range of policy documents. Our analysis drew on sociotechnical principles, combining deductive and inductive methods. RESULTS: Data comprised 508 interviews, 163 observed meetings, and analysis of 325 documents. We found little evidence of Blueprints being adopted in the manner originally conceived by national program managers. However, they proved effective in different ways to those planned. As well as providing a helpful initial guide to a topic, we found that Blueprints served as a method of identifying relevant expertise that paved the way for subsequent discussions and richer knowledge transfers amongst provider organizations. The primary value of Blueprinting, therefore, seemed to be its role as a networking tool. Members of different organizations came together in developing, applying, and sustaining Blueprints through bilateral conversations—in some circumstances also fostering informal communities of practice. CONCLUSIONS: Blueprints may be effective in facilitating knowledge transfer among healthcare organizations, but need to be accompanied by other evolving methods, such as site visits and other networking activities, to iteratively transfer knowledge and experience

Formative independent evaluation of a digital change programme in the English National Health Service:Study protocol for a longitudinal qualitative study

INTRODUCTION: Many countries are launching large-scale, digitally enabled change programmes as part of efforts to improve the quality, safety and efficiency of care. We have been commissioned to conduct an independent evaluation of a major national change programme, the Global Digital Exemplar (GDE) Programme, which aims to develop exemplary digital health solutions and encourage their wider adoption by creating a learning ecosystem across English National Health Service (NHS) provider organisations. METHODS AND ANALYSIS: This theoretically informed, qualitative, longitudinal formative evaluation comprises five inter-related work packages. We will conduct a combination of 12 in-depth and 24 broader qualitative case studies in GDE sites exploring digital transformation, local learning and mechanisms of spread of knowledge within the Programme and across the wider NHS. Data will be collected through a combination of semistructured interviews with managers, implementation staff (clinical and non-clinical), vendors and policymakers, plus non-participant observations of meetings, site visits, workshops and documentary analysis of strategic local and national plans. Data will be analysed through inductive and deductive methods, beginning with in-depth case study sites and testing the findings against data from the wider sample and national stakeholders. ETHICS AND DISSEMINATION: This work is commissioned as part of a national change programme and is therefore a service evaluation. We have ethical approval from the University of Edinburgh. Results will be disseminated at six monthly intervals to national policymakers, and made available via our publicly accessible website. We will also identify lessons for the management and evaluation of large-scale evolving digital health change programmes that are of international relevance

Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

BACKGROUND: Attempts to achieve digital transformation across the health service have stimulated increasingly large-scale and more complex change programmes. These encompass a growing range of functions in multiple locations across the system and may take place over extended timeframes. This calls for new approaches to evaluate these programmes. MAIN BODY: Drawing on over a decade of conducting formative and summative evaluations of health information technologies, we here build on previous work detailing evaluation challenges and ways to tackle these. Important considerations include changing organisational, economic, political, vendor and markets necessitating tracing of evolving networks, relationships, and processes; exploring mechanisms of spread; and studying selected settings in depth to understand local tensions and priorities. CONCLUSIONS: Decision-makers need to recognise that formative evaluations, if built on solid theoretical and methodological foundations, can help to mitigate risks and help to ensure that programmes have maximum chances of success

Supporting thinking on sample sizes for thematic analyses: a quantitative tool

Thematic analysis is frequently used to analyse qualitative data in psychology, healthcare, social research and beyond. An important stage in planning a study is determining how large a sample size may be required, however current guidelines for thematic analysis are varied, ranging from around 2 to over 400 and it is unclear how to choose a value from the space in between. Some guidance can also not be applied prospectively. This paper introduces a tool to help users think about what would be a useful sample size for their particular context when investigating patterns across participants. The calculation depends on (a) the expected population theme prevalence of the least prevalent theme, derived either from prior knowledge or based on the prevalence of the rarest themes considered worth uncovering, e.g. 1 in 10, 1 in 100; (b) the number of desired instances of the theme; and (c) the power of the study. An adequately powered study will have a high likelihood of finding sufficient themes of the desired prevalence. This calculation can then be used alongside other considerations. We illustrate how to use the method to calculate sample size before starting a study and achieved power given a sample size, providing tables of answers and code for use in the free software, R. Sample sizes are comparable to those found in the literature, for example to have 80% power to detect two instances of a theme with 10% prevalence, 29 participants are required. Increasing power, increasing the number of instances or decreasing prevalence increases the sample size needed. We do not propose this as a ritualistic requirement for study design, but rather as a pragmatic supporting tool to help plan studies using thematic analysis

Computer aids and human second reading as interventions in screening mammography: Two systematic reviews to compare effects on cancer detection and recall rate

Background: There are two competing methods for improving the accuracy of a radiologist interpreting screening mammograms: computer aids (CAD) or independent second reading. Methods: Bibliographic databases were searched for clinical trials. Meta-analyses estimated impacts of CAD and double reading on odds ratios for cancer detection and recall rates. Sub-group analyses considered double reading with arbitration. Results: Ten studies compared single reading with CAD to single reading. Seventeen compared double to single reading. Double reading increases cancer detection and recall rates. Double reading with arbitration increases detection rate (CI: 1.02-1.15) and decreases recall rate (CI: 0.92-0.96). CAD does not have a significant effect on cancer detection rate (CI: 0.96-1.13) and increases recall rate (95% CI: 1.09-1.12). However, there is considerable heterogeneity in the impact on recall rate in both sets of studies. Conclusion: The evidence that double reading with arbitration enhances screening is stronger than that for single reading with CAD

Engagement with protective behaviours in the UK during the COVID-19 pandemic:a series of cross-sectional surveys (the COVID-19 rapid survey of adherence to interventions and responses [CORSAIR] study)

BACKGROUND: Behaviour is key to suppressing the COVID-19 pandemic. Maintaining behaviour change can be difficult. We investigated engagement with hand cleaning, reducing the number of outings, and wearing a face covering over the course of the pandemic. METHODS: We used a series of 64 cross-sectional surveys between 10 February 2020 and 20 January 2022 (n ≈ 2000 per wave). Surveys investigated uptake of hand cleaning behaviours, out of home activity (England only, n ≈ 1700 per wave) and wearing a face covering (England only, restricted to those who reported going out shopping in the last week, n ≈ 1400 per wave). RESULTS: Reported hand cleaning has been high throughout the pandemic period (85 to 90% of participants consistently reporting washing their hands thoroughly and regularly with soap and water frequently or very frequently). Out of home activity has mirrored the easing and re-introduction of restrictive measures. Total number of outings were higher in the second national lockdown than in the first and third lockdowns. Wearing a face covering increased steadily between April to August 2020, plateauing until the end of measurement in May 2021, with approximately 80% of those who had been out shopping in the previous week reporting wearing a face covering frequently or very frequently. CONCLUSIONS: Engagement with protective behaviours increased at the start of the pandemic and has remained high since. The greatest variations in behaviour reflected changes to Government rules. Despite the duration of restrictions, people have continued to adopt personal protective behaviours that were intended to prevent the spread of COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-12777-x