Implementation and adoption of nationwide electronic health records in secondary care in England

Qualitative analysis of interim results from a prospective national evaluation

Ann Robertson, Kathrin Cresswell, Amirhossein Takian, Dimitra Petrakaki, Sarah Crowe, Tony Cornford, Nicholas Barber, Anthony Avery, Bernard Fernando, Ann Jacklin, Robin Prescott, Ela Klecun, James Paton, Valentina Lichtner, Casey Quinn, Maryam Ali, Zoe Morrison, Yogini Jani, Justin Waring, Kate Marsden & 1 others Aziz Sheikh*

*Corresponding author for this work

Research output: Contribution to journalArticle

135 Citations (Scopus)
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Abstract

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 hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete. Data sources and analysis: Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data. Main results: Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a "middle-out" approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities. Conclusions: Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations' perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems.

Original languageEnglish
Article numberc4564
Number of pages12
JournalBMJ
Volume341
Issue number7778
DOIs
Publication statusPublished - 2 Sep 2010

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Secondary Care
Electronic Health Records
England
Contracts
Financial Support
Frustration
Information Storage and Retrieval
Politics
Mental Health
Communication
Organizations
Interviews
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Implementation and adoption of nationwide electronic health records in secondary care in England : Qualitative analysis of interim results from a prospective national evaluation. / Robertson, Ann; Cresswell, Kathrin; Takian, Amirhossein; Petrakaki, Dimitra; Crowe, Sarah; Cornford, Tony; Barber, Nicholas; Avery, Anthony; Fernando, Bernard; Jacklin, Ann; Prescott, Robin; Klecun, Ela; Paton, James; Lichtner, Valentina; Quinn, Casey; Ali, Maryam; Morrison, Zoe; Jani, Yogini; Waring, Justin; Marsden, Kate; Sheikh, Aziz.

In: BMJ, Vol. 341, No. 7778, c4564, 02.09.2010.

Research output: Contribution to journalArticle

Robertson, A, Cresswell, K, Takian, A, Petrakaki, D, Crowe, S, Cornford, T, Barber, N, Avery, A, Fernando, B, Jacklin, A, Prescott, R, Klecun, E, Paton, J, Lichtner, V, Quinn, C, Ali, M, Morrison, Z, Jani, Y, Waring, J, Marsden, K & Sheikh, A 2010, 'Implementation and adoption of nationwide electronic health records in secondary care in England: Qualitative analysis of interim results from a prospective national evaluation', BMJ, vol. 341, no. 7778, c4564. https://doi.org/10.1136/bmj.c4564
Robertson, Ann ; Cresswell, Kathrin ; Takian, Amirhossein ; Petrakaki, Dimitra ; Crowe, Sarah ; Cornford, Tony ; Barber, Nicholas ; Avery, Anthony ; Fernando, Bernard ; Jacklin, Ann ; Prescott, Robin ; Klecun, Ela ; Paton, James ; Lichtner, Valentina ; Quinn, Casey ; Ali, Maryam ; Morrison, Zoe ; Jani, Yogini ; Waring, Justin ; Marsden, Kate ; Sheikh, Aziz. / Implementation and adoption of nationwide electronic health records in secondary care in England : Qualitative analysis of interim results from a prospective national evaluation. In: BMJ. 2010 ; Vol. 341, No. 7778.
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AU - Petrakaki, Dimitra

AU - Crowe, Sarah

AU - Cornford, Tony

AU - Barber, Nicholas

AU - Avery, Anthony

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AU - Prescott, Robin

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