Introducing a nationally shared electronic patient record: Case study comparison of Scotland, England, Wales and Northern Ireland
Introducing a nationally shared electronic patient record: Case study comparison of Scotland, England, Wales and Northern Ireland
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DOI：
10.1016/j.ijmedinf.2013.01.002
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发表时间：
2013-05-01
影响因子：
4.9
通讯作者：
Gunning, Katey
中科院分区：
文献类型：
--
作者：
Greenhalgh, Trisha;Morris, Libby;Gunning, Katey
目的：比较联合王国四个国家在引入全国可访问的患者关键医疗细节电子摘要方面的经验，旨在用于紧急和计划外护理事件，并为其他国家提供可转移的经验教训。方法：对先前收集的四种方案的资料进行二次分析；利用创新扩散理论衍生的框架进行跨案例比较。主要发现：虽然所有四个项目都有相似的愿景，但它们在战略、预算、实施计划、临床和公众参与的方法以及评估和学习的方法方面存在很大差异。由于各种原因，它们在利益相关者的结盟、对项目的抵制的性质和程度以及创建记录的速度方面也存在差异。全国共享、可广泛获取的电子记录具有强大的象征意义；它可能会也可能不会被视为提高护理质量和安全，或者（或者）威胁到病人的隐私或医生或护士的传统角色。当“硬”项目管理与项目的“软”方面相交叉时，以实现特定的里程碑和最后期限为导向的“硬”项目管理有时会适得其反。结论：在设计和实施具有普遍影响的复杂技术时，决策者不仅要考虑技术问题，还要考虑项目的个人、社会和组织方面。明智地将“硬”管理和“软”管理结合起来，似乎是管理此类项目的关键。2013爱思唯尔爱尔兰有限公司版权所有。
Aim: To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries.Method: Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory.Main findings: Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes.Conclusion: When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes. (c) 2013 Elsevier Ireland Ltd. All rights reserved.