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

BMJ, 2008-11, Vol.337 (7677), p.1040-1044 [Peer Reviewed Journal]

Greenhalgh et al 2008 ;Copyright 2008 BMJ Publishing Group Ltd. ;2008 INIST-CNRS ;Copyright BMJ Publishing Group LTD Oct 23, 2008 ;Greenhalgh et al 2008 2008 Greenhalgh et al ;ISSN: 0959-8138 ;ISSN: 0959-8146 ;EISSN: 1468-5833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.a1786 ;PMID: 18948344 ;CODEN: BMJOAE

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  • Title:
    Introduction of shared electronic records: multi-site case study using diffusion of innovation theory
  • Author: Greenhalgh, Trisha ; Stramer, Katja ; Bratan, Tanja ; Byrne, Emma ; Mohammad, Yara ; Russell, Jill
  • Subjects: Biological and medical sciences ; Decision Making ; Diffusion of Innovation ; Early adopters ; Electronic health records ; Electronic records ; England ; General aspects ; General practice ; Health care industry ; Health care organizations ; Hospital Information Systems - organization & administration ; Humans ; Information technology ; Medical Record Linkage ; Medical Records Systems, Computerized - organization & administration ; Medical sciences ; Miscellaneous ; Modeling ; Primary health care ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Records management ; Rural Health ; Socioeconomic factors ; Technological innovation ; Urban Health ; Workloads
  • Is Part Of: BMJ, 2008-11, Vol.337 (7677), p.1040-1044
  • Description: Objective To explore the introduction of a centrally stored, shared electronic patient record (the summary care record (SCR)) in England and draw wider lessons about the implementation of large scale information technology projects in health care.Design Multi-site, mixed method case study applying utilisation focused evaluation.Setting Four early adopter sites for the SCR in England—three in urban areas of relative socioeconomic deprivation and the fourth in a relatively affluent rural area.Data sources and analysis Data included 250 staff interviews, 1500 hours of ethnographic observation, interviews and focus groups with 170 patients and carers, 2500 pages of correspondence and documentary evidence, and incorporation of relevant surveys and statistics produced by others. These were analysed by using a thematic approach drawing on (and extending) a theoretical model of complex change developed in a previous systematic review.Main findings The mixed fortunes of the SCR programme in its first year were largely explained by eight interacting influences. The first was the SCR’s material properties (especially technical immaturity and lack of interoperability) and attributes (especially the extent to which potential adopters believed the benefits outweighed the risks). The second was adopters’ concerns (especially about workload and the ethicality of sharing “confidential” information on an implied consent model). The third influence was interpersonal influence (for example, opinion leaders, champions, facilitators), and the fourth was organisational antecedents for innovation (for example past experience with information technology projects, leadership and management capacity, effective data capture systems, slack resources). The fifth was organisational readiness for the SCR (for example, innovation-system fit, tension for change, power balances between supporters and opponents, baseline data quality). The sixth was the implementation process (including the nature of the change model and the extent to which new routines associated with the SCR aligned with existing organisational routines). The seventh influence was the nature and quality of links between different parts of the system, and the final one was the wider environment (especially the political context of the programme).Conclusion Shared electronic records are not plug-in technologies. They are complex innovations that must be accepted by individual patients and staff and also embedded in organisational and inter-organisational routines. This process is heavily influenced at the micro-level by the material properties of the technology, individuals’ attitudes and concerns, and interpersonal influence; at the meso-level by organisational antecedents, readiness, and operational aspects of implementation; and at the macro-level by institutional and socio-political forces. A case study approach and multi-level theoretical analysis can illuminate how contextual factors shape, enable, and constrain new, technology supported models of patient care.
  • Publisher: London: British Medical Journal Publishing Group
  • Language: English
  • Identifier: ISSN: 0959-8138
    ISSN: 0959-8146
    EISSN: 1468-5833
    EISSN: 1756-1833
    DOI: 10.1136/bmj.a1786
    PMID: 18948344
    CODEN: BMJOAE
  • Source: BMJ Open Access Journals
    MEDLINE
    Alma/SFX Local Collection
    ProQuest Central
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