Implementing the NHS Information Technology Programme: Qualitative Study of Progress in Acute Trusts

Innovation Studies Centre, Imperial College, London SW7 2AZ.
BMJ (online) (Impact Factor: 17.45). 07/2007; 334(7608):1360. DOI: 10.1136/bmj.39195.598461.551
Source: PubMed


To describe progress and perceived challenges in implementing the NHS information and technology (IT) programme in England.
Case studies and in-depth interviews, with themes identified using a framework developed from grounded theory. We interviewed personnel who had been interviewed 18 months earlier, or new personnel in the same posts.
Four NHS acute hospital trusts in England.
Senior trust managers and clinicians, including chief executives, directors of IT, medical directors, and directors of nursing.
Interviewees unreservedly supported the goals of the programme but had several serious concerns. As before, implementation is hampered by local financial deficits, delays in implementing patient administration systems that are compliant with the programme, and poor communication between Connecting for Health (the agency responsible for the programme) and local managers. New issues were raised. Local managers cannot prioritise implementing the programme because of competing financial priorities and uncertainties about the programme. They perceive a growing risk to patients' safety associated with delays and a loss of integration of components of the programme, and are discontented with Choose and Book (electronic booking for referrals from primary care).
We recommend that the programme sets realistic timetables for individual trusts and advises managers about interim IT systems they have to purchase because of delays outside their control. Advice needs to be mindful of the need for trusts to ensure longer term compatibility with the programme and value for money. Trusts need assistance in prioritising modernisation of IT by, for example, including implementation of the programme in the performance management framework. Even with Connecting for Health adopting a different approach of setting central standards with local implementation, these issues will still need to be addressed. Lessons learnt in the NHS have wider relevance as healthcare systems, such as in France and Australia, look to realise the potential of large scale IT modernisation.

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Available from: Jane Hendy
    • "Recently, provinces and territories have developed specific programs and agencies enabling the implementation, support and adoption of EHR, but some are at the early stages (Canada's Health Informatics Association, 2013). Unlike other incentives programs implemented in the US (Blumenthal, 2009Blumenthal, , 2010) and the UK (Greenhalgh et al., 2010;Hendy, Fulop, Reeves, Hutchings, & Collin, 2007), EHR implementation in Canada is mostly under the responsibility of provincial and territorial jurisdictions. Furthermore, as primary care organizations are relatively autonomous in Canada, the decision to implement EHR remains largely dependent upon the willingness of physicians , although some organizational factors, such as the presence of incentives and support for clinicians, are likely to influence individual decision to adopt the EHR (Pare et al., 2014). "
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    ABSTRACT: In Canada, the healthcare system remains paper-laden, and EHR adoption by physicians lags behind many other industrial countries. Recent reviews identified individual and organizational factors as having the most important influence on EHR adoption and proposed taking a multidimensional perspective to study these adoption determinants. However, most studies have focused on physician EHR adoption measured at the individual level. Objectives First, we used a multilevel regression model to assess whether organizations' characteristics influenced physician behavioral intention to use EHR. Second, we sought to identify individual and organizational factors that explain physician intention. Methods We conducted a prospective cross-sectional study among physicians in 49 primary healthcare organizations in four regions of the province of Quebec (Canada). We first analyzed relationships between individual and organizational variables and intention. Second, we performed multilevel modeling to explore organizational characteristics' impact on physician intention to use EHR. Results 278 completed questionnaires were returned from the 31 organizations that had at least 5 participants (response rate: 39.8%). Questionnaires showed satisfactory psychometric properties. The multilevel modeling found no significant overall influence of organizational level on physician intention to use EHR. Second, six of the individual level constructs had a positive and strongly significant impact on physician intention. Conclusion In the Quebec context, organization-level seems to have no significant impact on EHR adoption by physicians. Hence, particular strategies are more likely to succeed if they target individual physicians rather than organizations.
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    • "With rising acceptability, eHealth and mHealth initiatives are steadily emerging in both developing and highly industrialized countries, though with variable and sometimes counter-intuitive outcomes. For example, while there is evidence that an SMS based sentinel system has substantially improved disease surveillance in Madagascar [32], the highly sophisticated UK National Health System recently had to abandon a major national IT program to centralize patient records in midcourse [33,34]. In Bangladesh, WHO reported that the MoHFW reached 98% of its target population through SMS on health education but did not provide messages in Bangla, which is the first language of the majority of the population [14]. "
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    • "Outline of deliverables within the NHS IT programme (Hendy, Fulop, Reeves, Hutchings, & Collins, 2007) "
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