Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals.
Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals.
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DOI：
10.1136/bmj.d6054
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发表时间：
2011-10-17
期刊：
影响因子：
--
通讯作者：
Cresswell K
中科院分区：
文献类型：
--
作者：
Sheikh A;Cornford T;Barber N;Avery A;Takian A;Lichtner V;Petrakaki D;Crowe S;Marsden K;Robertson A;Morrison Z;Klecun E;Prescott R;Quinn C;Jani Y;Ficociello M;Voutsina K;Paton J;Fernando B;Jacklin A;Cresswell K
目的评价英国“早期采用者”医院实施和采用NHS详细护理记录服务的情况。基于案例研究的纵向定性评价。设置12个“早期采用者”NHS急性医院和专科护理机构研究了两年半。通过深入访谈、观察和与案例研究地点直接相关的相关文件收集数据，并与被认为对实施战略有影响的更广泛的国家发展直接相关。数据是按主题分析的，最初是在病例内部，然后是跨病例。该数据集包括对关键利益相关者的431次半结构化访谈，包括医院员工、开发商和政府利益相关者；对战略会议进行590小时的观察和在适当情况下使用软件；334套观察笔记、研究人员实地笔记和国家会议笔记；809份NHS文件；以及58份地区和国家文件。结果实施进展缓慢，范围窄，临床功能明显低于原计划。国家战略在当地产生了相当大的影响（总结为五个关键主题），更广泛的国家发展对执行和采用产生了重大影响。更具体地说，延迟与对系统能力不切实际的期望有关；构建、配置和定制软件所需的时间；确保各系统支持提供护理所需的工作；以及最终用户对培训和支持的需求。阻碍进展的其他因素包括国民保健服务政策和优先事项环境的变化；反复重新谈判国家合同；不同NHS病历服务系统发展的不同阶段；不同利益相关者之间复杂的沟通过程，以及在很大程度上将NHS提供者排除在外的合同安排。有早期的证据表明，部署系统导致组织内部和组织之间的重要学习和NHS医院内相关能力的发展。结论：在“早期采用者”站点实施NHS护理记录服务耗时且具有挑战性，对临床医生的益处有限，对患者的益处也不明显。虽然我们的结果可能不能直接转移到后来采用的站点，因为我们评估的功能是新的，在英语环境中没有尝试过，但它们揭示了实现主要新系统所涉及的过程。我们在中期分析的基础上提倡的增加地方决策的举措受到了NHS的追捧和欢迎，但重要的是，政策制定者不要忽视集成互操作解决方案的总体目标。
Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals. Conclusions Implementation of the NHS Care Records Service in “early adopter” sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution.
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影响因子：
2.8
作者：
Boonstra A;Broekhuis M
通讯作者：
Broekhuis M
DOI：
10.1197/jamia.m1097
发表时间：
2003-01-01
影响因子：
6.4
作者：
Bates, DW;Ebell, M;Mullins, HC
通讯作者：
Mullins, HC
DOI：
10.1197/jamia.m1372
发表时间：
2004-05-01
影响因子：
6.4
作者：
Aarts, J;Doorewaard, H;Berg, M
通讯作者：
Berg, M
影响因子：
5.6
作者：
Brennan, Sean
通讯作者：
Brennan, Sean
DOI：
10.1016/j.ijmedinf.2006.01.001
发表时间：
2007-01-01
影响因子：
4.9
作者：
Bossen, Claus
通讯作者：
Bossen, Claus