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| Timeline showing some key developments in the NHS National Programme for IT (NPfIT) in England and some key publications
Source publication
To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service.
A mixed methods, longitudinal, multisite, socio-technical case study.
Five NHS acute hospital and mental health tru...
Context in source publication
Context 1
... it has attracted negative media coverage and critical questioning by parliamentary bodies charged with scrutinising government spending. Table 2 gives a timeline of programme developments, including some key parliamentary and independent reports pub- lished in the course of the programme. ...
Similar publications
OBJECTIVES: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. DESIGN: A mixed methods, longitudinal, multisite, socio-technical case study. SETTING: Five NHS acute h...
Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perc...
Citations
... It includes patients, doctors, nurses, and other users who collect clinical and administrative data. This process is carried out independently in the same environment or in different environments at the local and national levels [47][48][49]. We highlight in the next paragraphs the main HISs in the context of the topic in question. ...
... Some studies in the literature observed that there was variation in the adoption of these systems. This variation is associated with the low rate associated with causes by organizational and financial factors, lack of experience of health professionals, and technological knowledge [49,60]. In this context, it is important to emphasize that the adoption of HISs by health professionals is a great challenge. ...
Aims:
This article aims to perform a Systematic Literature Review (SLR) to better understand the structures of different methods, techniques, models, methodologies, and technologies related to provenance data management in health information systems (HISs). The SLR developed here seeks to answer the questions that contribute to describing the results.
Method:
An SLR was performed on six databases using a search string. The backward and forward snowballing technique was also used. Eligible studies were all articles in English that presented on the use of different methods, techniques, models, methodologies, and technologies related to provenance data management in HISs. The quality of the included articles was assessed to obtain a better connection to the topic studied.
Results:
Of the 239 studies retrieved, 14 met the inclusion criteria described in this SLR. In order to complement the retrieved studies, 3 studies were included using the backward and forward snowballing technique, totaling 17 studies dedicated to the construction of this research. Most of the selected studies were published as conference papers, which is common when involving computer science in HISs. There was a more frequent use of data provenance models from the PROV family in different HISs combined with different technologies, among which blockchain and middleware stand out. Despite the advantages found, the lack of technological structure, data interoperability problems, and the technical unpreparedness of working professionals are still challenges encountered in the management of provenance data in HISs.
Conclusion:
It was possible to conclude the existence of different methods, techniques, models, and combined technologies, which are presented in the proposal of a taxonomy that provides researchers with a new understanding about the management of provenance data in HISs.
... Due to increasing healthcare costs and its effect on productivity, governments across the world are attempting to design and implement systems that can provide affordable and quality healthcare to their citizens. The potential benefits offered by healthcare technologies such as Electronic Health Records (EHR) have prompted governments to design and implement large-scale health IT projects (Robertson et al., 2010). While the adoption of technology in healthcare has been generally poor (Baus, 2004;Kaplan & Harris-Salamone, 2009;Littlejohns et al., 2003) the failure rate has been especially high in large scale projects (Goldfinch, 2007;Mason et al., 2017). ...
Patient-centric digital infrastructure can potentially enhance the efficiency of healthcare systems. However, even in developed nations, evidence suggests low adoption rates for such infrastructure and lack of support from clinicians is considered as one of the most critical hindering factors. In this study, we examine physicians' perceptions of the proposed large-scale information technology initiative in India that aims to transform the health sector and provide universal health coverage to all residents of India. We employed the information ecology lens to understand the broader changes in the healthcare system that could result from the initiative. We use focus group discussion and in-depth interviews to comprehend the perceptions of doctors about the initiative. Drawing upon Foucault’s conceptualization of power, we find that physicians, the key stakeholders in this initiative, are skeptical about the changes in the locus of power in the new ecosystem. Specifically, they perceive that knowledge power has shifted from a historical “expert knowledge power” to power related to “data management.” The physicians believe that changes are expected to manifest through monitoring, controlling, and managing the data rather than providing knowledge-based services. We present recommendations to engage physicians' perspectives in implementing large-scale patient-centric digital infrastructure.
... Which includes patients, doctors, nurses and others who collect clinical and administrative data. This process in accomplished regardless of whether in the same or different environment in local or national levels [16,17,18]. ...
On the one hand, data provenance provides the history of the origin of data and updates the modification cycle on one side, on the other hand, blockchain offers features that meet these immutability requirements of a version of data. These two technologies have applications and features that, in union, contribute to generate ideal technological structures to the management of data in several organizations. The objective of this study is to present an analysis of the relations between the main applications of data provenance as well as the blockchain features and point out applications in the Health Information Systems (HIS), in addition to a literature review on the theme. In regard to that, an analysis has been made as described in this study methodology, where the following questions were answered: i) What relations are there between data provenance and blockchain? ii) Can data provenance in union with blockchain contribute to applications in the HIS? Soon after, it was possible to prove through some of the studies present in the literature the combined use of data provenance and blockchain in HIS. Based on the relationships found between data provenance and blockchain, it was possible to conclude that these relationships contribute to data management in any organization, including HIS. It was also observed that different data provenance and blockchain methods, techniques, models, and methodologies are intertwined to generate the structures of data management in HIS, especially in Personal Health Record (PHR) and Electronic Health Record (EHR).KeywordsData ProvenanceBlockchainHealth Information Systems
... Similarly to other national mixed methods evaluations of health policy in England, (Robertson et al., 2010) we planned to conduct an interim analysis using our time one case site data and interviews with national service leaders (n = 10). The aim of this work was to generate a set of hypotheses, some of which then could be addressed using the available HES data, in addition to informing follow-up qualitative case site data collection and analysis. ...
Over the past decade, there has been a growing trend towards the use of ‘big qualitative data’ in applied health research, particularly when used as part of mixed methods evaluations of health policy in England. These ‘big qualitative’ studies tend to be longitudinal, complex (multi-site and multi-stakeholder) and involve the use of multiple methods (interviews, observations, documents) and large numbers of participants (n=100+). Despite their growing popularity, there is no methodological guidance or methodological reflection on how to undertake such studies. Qualitative researchers are therefore faced with a series of unknowns when designing large qualitative studies, particularly in terms of knowing whether existing qualitative sampling and analysis methods are appropriate in this context. In this paper, we use our experience of undertaking a big qualitative study, as part of a national mixed methods evaluation of a health policy in England to reflect on some of the key challenges that we faced in our qualitative study, which broadly related to: sample size, data analysis and the role of patient and public engagement. Underpinning these difficulties was the challenge of being flexible and innovative within the largely positivist research climate of applied health research and being comfortable with uncertainty relating to the three issues outlined. The reflections we present are not to be viewed as a method ‘how to’ guide, but rather as a platform to raise key issues relating to the qualitative methods that we found challenging, in order to stimulate discussion and debate amongst the qualitative community. Through this paper, we therefore hope to demystify what it is like to undertake such a study and hope to spark much needed discussion and innovation to support the future design and conduct of qualitative research at scale.
... A range of study designs and research methods were represented in the included studies. Most were quantitative (21/40, 53%) , with qualitative (11/40, 28%) [99][100][101][102][103][104][105][106][107][108][109] and mixed method studies (8/40, 20%) [110][111][112][113][114][115][116][117] also included. We categorized studies based on the broad category of research methods, including surveys (15/40, 38%) [78,[80][81][82][83][84][85]89,92,[95][96][97]110,113,116], qualitative interview/focus group studies (7/40, 18%) [100][101][102][103][104]110,111], chart review of specific EHRs (5/40, 13%) [85][86][87]114,117], cross-sectional analysis of EHR data or comparison with other secondary data (5/40, 13%) [90,91,93,95,98], quality improvement initiatives (3/40, 8%) [79,88,111], ethnographic or observational (6/40, 15%) [99,[105][106][107][108]112], and descriptive case studies (1/40, 3%) [109]. ...
... Most were quantitative (21/40, 53%) , with qualitative (11/40, 28%) [99][100][101][102][103][104][105][106][107][108][109] and mixed method studies (8/40, 20%) [110][111][112][113][114][115][116][117] also included. We categorized studies based on the broad category of research methods, including surveys (15/40, 38%) [78,[80][81][82][83][84][85]89,92,[95][96][97]110,113,116], qualitative interview/focus group studies (7/40, 18%) [100][101][102][103][104]110,111], chart review of specific EHRs (5/40, 13%) [85][86][87]114,117], cross-sectional analysis of EHR data or comparison with other secondary data (5/40, 13%) [90,91,93,95,98], quality improvement initiatives (3/40, 8%) [79,88,111], ethnographic or observational (6/40, 15%) [99,[105][106][107][108]112], and descriptive case studies (1/40, 3%) [109]. ...
... We also included the publication years in Table 2 to showcase how certain topics were not confined to any specific period. [116] and 2018 [94] Exploring the adoption of EHRs a in the mental health care context 2009 [78], 2010 [107], 2011 [108], 2012 [99], 2017 [79], and 2018 [110] Evaluation of an EHR implementation 2013 [80] and 2015 [81] Exploring the use of EHRs to provide mutual access to psychiatric records 2010 [82], 2011 [84] 2017 [101], 2019 [111], 2020 [83], and 2020 [85] Exploring the impact of EHRs on the therapeutic relationship or person-centered care 2012 [113], 2012 [113], 2015 [112], 2015 [81], and 2018 [86] Exploring the use of EHRs in integrated or collaborative care contexts 2007 [87], 2016 [88], and 2018 [114] Comparing documentation in EHRs with documentation in paper records 2018 [110] and 2020 [90] Exploring service users' experiences or satisfaction with care when an EHR is present 2010 [103], 2011 [108], 2012 [113], 2012 [99], 2013 [109], 2014 [100], 2015 [116], 2015 [112], 2017 [115], 2017 [101], and 2021 [102] Exploring the barriers, facilitators, workarounds, and usability of EHRs in the mental health context 2004 [105], 2010 [106], and 2016 [104] Exploring the impact of EHRs on health care professionals' information practices and behavior 2009 [89], 2015 [92], and 2018 [110] Exploring clinicians' satisfaction and perspectives of EHRs 2013 [117], 2016 [91], 2016 [95], 2016 [96], 2019 [93] 2020 [98], and 2020 [97] Exploring information availability or documentation of specific diagnoses in EHRs a EHR: electronic health record. ...
Background
The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided.
Objective
This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts.
Methods
We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions.
Results
The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used.
Conclusions
We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
... Electronic health records (EHRs) are essential in attempting to update modern health care [1] and are being introduced across Europe, North America, Australasia, and the Middle East [2]. The change from paper to electronic records has been described as complex [3], particularly in the hospital setting compared to private industry, due to the nature of the organizational setting that involves caring and curing, data security, confidentiality, and data accuracy [4]. ...
Electronic health records (EHRs) are being introduced worldwide. The change from paper to electronic records has not always been a seamless or quick process; however, EHRs are viewed as central to updating modern health care, especially organization structures and delivery of sustainable care with the potential for joint decision-making with the patient. The objective of this viewpoint paper is to outline how an EHR is being developed in Ireland. The focus of the Maternal & Newborn Clinical Management System project is the design and implementation of an EHR for all women and babies in the maternity services in the Republic of Ireland. The paper also outlines the lessons learned from the planning to the optimization stage of the project. The paper was developed through discussions with the project management team and their completed reports that outline the lessons they acquired from each project stage. Key lessons learned from each stage of the project are highlighted. This viewpoint paper explains how the national project management team is implementing the EHR and outlines the experiences and lessons learned and the challenges ahead following the phase one introduction. The Maternal & Newborn Clinical Management System is an example of a clinician-led, patient-focused, change management project from its inception to implementation. The introduction of EHRs is essential in modernizing health care and optimizing patient outcomes through the accurate and appropriate use of data.
... The use of telehealth in a variety of chronic health conditions, such as heart failure and chronic obstructive pulmonary disease (COPD), has been studied [9,10] and there is a growing body of research into its application in palliative medicine. Although there have been some large-scale notable uses of telehealth; for example, the use of electronic patient record systems in the UK [11], the importance of telehealth in providing quality healthcare has only recently become more widely accepted. Used to its full potential, telehealth technology could be particularly vital in improving access to healthcare over geographical distance and outside of normal working hours [12]. ...
Background:
Telehealth is growing and its application in palliative care is seen as a solution to pressures on palliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of evidence-based research to support its use. The primary aim of this review was to describe the current use of telehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The secondary aim was to explore whether telehealth results in a reduction in emergency care access.
Methods:
Systematic review of the literature with thematic synthesis. Records were screened and data extracted by two reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were searched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking was also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038.
Results:
The search identified 3807 titles and 30 studies were included in the review. Telehealth was used to support patients and carers, electronic record keeping and professional education. Notably, the number of home telemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were small scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently detailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some extent. Seven studies made reference to emergency care access.
Conclusions:
Although there is growth of telehealth services, there remains a lack of evaluation and robust study design meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn. There is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is needed to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service standards.
... In Israel, hospitals across the country have voluntarily adopted dbMotion and thereby established the Israeli National Health Record, which allows for information to be integrated on demand, often in less than 8 s. 2 In 2002, England began movement on National Health Service (NHS) Care Records Service as a government driven, national software solution. 3 However, the authors of a longitudinal study argue that the initial plan for a top-down approach have incorporated elements more similar to the USA, where incentives are provided for compliance with standards. 3 In the USA, there is reliance on HIEs for data sharing. ...
... 3 However, the authors of a longitudinal study argue that the initial plan for a top-down approach have incorporated elements more similar to the USA, where incentives are provided for compliance with standards. 3 In the USA, there is reliance on HIEs for data sharing. Even within one integrated healthcare system, different instantiations of a single record system could impact record availability and views. ...
... Maintenance of some local control, as opposed to full standardisation, was one theme resulting from a study of the roll-out of the NHS Care Records Service in England. 3 Some see the concept of HIEs as being more flexible over the long term. 4 Despite the increasing adoption rates of HIE systems across the healthcare industry, the actual use of HIE systems by users remains minimal, with usage statistics reported to be less than 5% in some cases. 1 A systematic review conducted by the Agency for Healthcare Research and Quality outlined many of the barriers that may explain the discrepancy between health information technology (HIT) availability and the adoption of users who have yet to embrace it. ...
Background
The promise of Health Information Exchange (HIE) systems rests in their potential to provide clinicians and administrative staff rapid access to relevant patient data to support judgement and decision-making. However, HIE systems can have usability and technical issues, as well as fail to support user workflow.
Objective
Share the findings from a series of studies that address HIE system deficiencies for an Electronic Health Record (EHR) viewer which accesses multiple data sources.
Methods
A variety of methods were used, in a series of studies, to gain a better understanding of issues and their mitigation through use of promising EHR viewer features.
Results
The study series results are presented by the themes that underscore the importance for users to distinguish between data that are available but missing due to connection or system errors, data that are omitted entirely because they are not available and data that are excluded due to filtered search criteria.
Conclusions
The principal findings from this study series led to improvement recommendations for the EHR viewer, as well as citing areas that are ripe for further investigation and analysis.
... The implementation and adoption design of information systems has traditionally been a choice between a top-down and a bottom-up approach with consequences [21][22][23]. Major restructuring of services usually needs large scale information systems projects that suffer from recognized and well-documented problems [22][23][24], with published examples of failure [9,[25][26][27][28]. Barriers and facilitators to information systems adoption and data sharing in health care settings are identified in the literature [3,29,30]. ...
... The implementation and adoption design of information systems has traditionally been a choice between a top-down and a bottom-up approach with consequences [21][22][23]. Major restructuring of services usually needs large scale information systems projects that suffer from recognized and well-documented problems [22][23][24], with published examples of failure [9,[25][26][27][28]. Barriers and facilitators to information systems adoption and data sharing in health care settings are identified in the literature [3,29,30]. ...
... The larger the scale, the greater its chances of failure [31]. The past lessons and difficulties facing large information systems projects point, for example, towards modularisation [2,22,23,34]. Building national or large scale health information systems infrastructure is a problem entirely different from that of simply replicating a clinical system across many different institutions [21]. Implementation is not a simple straightforward linear process [9], and shared electronic patients' records are not just plug-in technologies [31]. ...
In Finland, implementation and adoption of the national Kanta services’ second phase services were carried out step-by-step from May 2010 till December 2017. The Kanta services currently include integrated, interoperable health information from EMR, EHR, PHR and social welfare sources that can benefit patients, care providers and policy makers. In Finland, the Ministry of Social Affairs and Health steers the Kanta services, and was responsible of the first phase implementation activities since July 2007. For the second phase of implementation and adoption of the services, a new national operational coordination function was established by law in January 2011. The adoption and implementation of the Kanta services would not have been possible without joint efforts of stakeholders and provision of adequate (state) funding. A set of indicators for various prospective, longitudinal monthly follow-up were used. The current principal Kanta services include My Kanta Pages (since May 2010), Prescription Centre (May 2010), Pharmaceutical Database (May 2010), Patient Data Repository and Patient Data Management Service (November 2013), Kelain (September 2016), and Client Data Archive for Social Welfare Services (May 2018) and Kanta Personal Health Record (May 2018).
... In recent years, EHRs have been implemented by an ever increasing number of hospitals around the world. There have, for example, been initiatives, often driven by government regulations or financial stimulations, in the UK ( Robertson et al, 2010), the USA ( Abramson et al, 2011), and Denmark (Rigsrevisionen, 2011). However, this is still an underdeveloped area of research in emerging economies such as India. ...
... Grimson et al (2000) claim that implementing an IS in hospitals is more exigent than anywhere else owing to the complexity of medical data, data migration, security and confidentiality concerns, and a general lack of awareness of the benefits of information technology. EHR systems can be used in individual organisations, as interoperating systems in affiliated healthcare units, on a regional level, or nationwide ( Robertson et al, 2010;Abramson et al, 2011). Healthcare service providers that use EHRs include hospitals, pharmacies, general practitioner surgeries, and other healthcare providers. ...
Technology enabled healthcare is transforming the healthcare sector by altering the way health services are delivered. An electronic health record system is one such intervention that has integrated technology with healthcare to improve the quality of care. Implementing an electronic health record system is a complex process involving multiple stakeholders. Research has shown that a substantial amount of projects fail, or are scrapped, leading to a loss in terms of finances effort and resources. It is, therefore, vital to identify the drivers, enablers and resistors of the electronic health record system implementation in order to gain a better understanding of the process. The majority of research on electronic health record initiatives has been undertaken in developed countries. However, there is a significant difference in infrastructure, regulatory policies, demographics and context between the developed and the developing countries, and the research from the developed countries cannot be wholeheartedly replicated in an emerging market. This article explores the drivers, enablers and resistors of the electronic health record system implementation. in a public hospital, in an emerging economy focusing on case based-evidence from India. The results are reflected in light of existing theories of change implementation and diffusion.
