Publisher version: http://www.bmj.com/content/340/bmj.c3111.full?sid=fcb22308-64fe-4070-9067-15a172b3aea

Bratan, T

Byrne, E

Greenhalgh, T

Potts, HWW

Russell, J

Stramer, K

English

OBJECTIVE: To evaluate a national programme to develop and implement centrally stored electronic summaries of patients' medical records. DESIGN: Mixed-method, multilevel case study. SETTING: English National Health Service 2007-10. The summary care record (SCR) was introduced as part of the National Programme for Information Technology. This evaluation of the SCR considered it in the context of national policy and its frontline implementation and use in three districts. Participants and methods Quantitative data (cumulative records created nationally plus a dataset of 416 325 encounters in participating primary care out-of-hours and walk-in centres) were analysed statistically. Qualitative data (140 interviews including policy makers, managers, clinicians, and software suppliers; 2000 pages of ethnographic field notes including observation of 214 clinical consultations; and 3000 pages of documents) were analysed thematically and interpretively. RESULTS: Creating individual SCRs and supporting their adoption and use was a complex, technically challenging, and labour intensive process that occurred more slowly than planned. By early 2010, 1.5 million such records had been created. In participating primary care out-of-hours and walk-in centres, an SCR was accessed in 4% of all encounters and in 21% of encounters where one was available; these figures were rising in some but not all sites. The main determinant of SCR access was the identity of the clinician: individual clinicians accessed available SCRs between 0 and 84% of the time. When accessed, an SCR seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a rare but important positive impact on preventing medication errors. SCRs sometimes contained incomplete or inaccurate data, but clinicians drew judiciously on these data along with other sources. SCR use was not associated with shorter consultations or reduction in onward referral. Successful introduction of SCRs depended on interaction between multiple stakeholders from different worlds (clinical, political, technical, commercial) with different values, priorities, and ways of working. The programme's fortunes seemed to turn on the ability of change agents to bridge these different institutional worlds, align their conflicting logics, and mobilise implementation effort. CONCLUSIONS: Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale

Greenhalgh, Trisha

Potts, HW

Oxford University Research Archive

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study.

ORA - Oxford University Research Archive

Oxford University Research Archive (ORA)

T. Greenhalgh

K. Stramer

T. Bratan

E. Byrne

J. Russell

H. W. W. Potts

Crossref

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Queen Mary Research Online

A paradoxical world: exploring the discursive construction of collaboration in a competitive institutional context.

A set of principles for conducting and evaluating interpretive field studies in information systems.MIS Quarterly

Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries.

Adoption and perception of electronic clinical communications in Scotland. Inform Prim Care

Adoptionof information technology in primary care physician offices in New Zealand and Denmark, part 1: healthcare system comparisons. Inform Prim Care

Adoptionof information technology in primary care physician offices in New Zealand and Denmark, part 2: historical comparisons. Inform Prim Care

Adoptionof information technology in primary care physician offices in New Zealand and Denmark, part 3: medical record environment comparisons. Inform Prim Care

Adoptionof information technology in primary care physician offices in New Zealand and Denmark, part 4: benefits comparisons. Inform Prim Care

Adoptionof information technology in primary care physician offices in New Zealand and Denmark, part 5: final comparisons. Inform Prim Care

Appealing work: an investigation of how ethnographic texts convince.Organization Science1993;4:595-616.

Building a national health IT system from the middle out.

Building a safer NHS for patients: improving medication safety. The Stationery Office,

Building theories from case study research. Acad Manage Rev

Comparison of information technology

Comprehensive spending review. HM Treasury,

Conflicting institutional logics: a national programme for IT in the organisational field of healthcare.

Creating citizen-consumers: New Labour and the remaking of public services. Public Policy and Administration

Data sharing: No additional data available.

Database state. Joseph Rowntree Reform Trust,

Delivering joined-up government in the UK: dimensions, issues and problems.

Denmark’s achievements with healthcare information exchange: case study G00139713. Gartner Industry Research,

Directionof travel for urgent care: a discussion document. The Stationery Office,

Discourse: a critical introduction.

Discriminating customers, responsible patients, empowered users: consumerism and the modernisation of health care.

Evaluating eHealth: how to make evaluation more methodologically robust.

Health. Better information, better choices, better health: putting information at the centre of health. The Stationery Office,

Health. Building the information core. Department of Health,

Health. Connecting for health: a guide to the National Programme for Information Technology. The Stationery Office,

Health. Delivering 21st century IT support for theNHS. Department of Health,

Health. Our health, our care, our say: a new direction for community services. The Stationery Office,

Health. The NHS informatics review report. The Stationery Office,

High quality health for all: NHS Next Stage Review Final Report. The Stationery Office,

Information for health: an information strategy for the modern NHS 1998-2005. NHS Executive,

Integration-complexity-risk: the making of information systems out-of-control.

Introduction of shared electronic records:multi-site case study using diffusion of innovation theory.

Management implications in information systems research: the untold story.

Modern public services for Britain: investing in reform. Comprehensive spending review: new public spending plans

Narrative methods for organizational and communication research.

Never heard of it”— understanding the public’s lack of awareness of a new electronic patient record. Health Expectations

NHS summary care record implementation strategic outline case. NHS Connecting for Health,

Office. BMA calls for roll-out of electronic patient records to be suspended.

Our NHS, our future. The Stationery Office,

Patients’ attitudes to the Summary Care Record and HealthSpace: qualitative study.

Securing our future health: taking a long-term view. HM Treasury,

Some elements of a sociology of translation: domestication of the scallops and the fishermen of St Brieuc

Summary Care Record scope. NHS Connecting for Health,

System, lifeworld and doctor-patient interaction: issues of trust in a changing world. In:

Systems of meaning: ethnography as a methodology for the study of information technologies.

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method.Milbank Q

The cathedral and the bazaar (open source publication).

The constant comparative method of qualitative analysis.

The devil’s in the detail: final report of the independent evaluation of the Summary Care Record and HealthSpace programmes.

The impact of eHealth on the quality and safety of healthcare: a systematic overview and synthesis of the literature. NHS Connecting for Health Evaluation Programme,

Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory. Soc Sci Med

Utilization-focused evaluation: the new century. 3rd ed. Sage,

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Abstract

Similar works

Full text

Available Versions

Oxford University Research Archive

ORA - Oxford University Research Archive

Oxford University Research Archive (ORA)

Crossref

Queen Mary Research Online