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

Analyzing Powers for pp → pnπ^+

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

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

Photoassociation spectroscopy of cold calcium atoms

Photoassociation spectroscopy experiments on 40Ca atoms close to the dissociation limit 4s4s 1S0 - 4s4p 1P1 are presented. The vibronic spectrum was measured for detunings of the photoassociation laser ranging from 0.6 GHz to 68 GHz with respect to the atomic resonance. In contrast to previous measurements the rotational splitting of the vibrational lines was fully resolved. Full quantum mechanical numerical simulations of the photoassociation spectrum were performed which allowed us to put constraints on the possible range of the calcium scattering length to between 50 a_0 and 300 a_0

Systematic review of economic evaluations and cost analyses of guideline implementation strategies

Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.Peer reviewedAuthor versio

Electromigration-Induced Flow of Islands and Voids on the Cu(001) Surface

Electromigration-induced flow of islands and voids on the Cu(001) surface is studied at the atomic scale. The basic drift mechanisms are identified using a complete set of energy barriers for adatom hopping on the Cu(001) surface, combined with kinetic Monte Carlo simulations. The energy barriers are calculated by the embedded atom method, and parameterized using a simple model. The dependence of the flow on the temperature, the size of the clusters, and the strength of the applied field is obtained. For both islands and voids it is found that edge diffusion is the dominant mass-transport mechanism. The rate limiting steps are identified. For both islands and voids they involve detachment of atoms from corners into the adjacent edge. The energy barriers for these moves are found to be in good agreement with the activation energy for island/void drift obtained from Arrhenius analysis of the simulation results. The relevance of the results to other FCC(001) metal surfaces and their experimental implications are discussed.Comment: 9 pages, 13 ps figure