Mannan Rishi, Murphy Jeannette, Jones Melvyn
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
Inform Prim Care. 2006;14(2):121-31. doi: 10.14236/jhi.v14i2.622.
e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes.
Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers.
Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study.
A north London PCT with 62 general practices. Four practices were selected for the study.
Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care.
At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice.
电子健康是指利用互联网及相关技术来组织和提供卫生服务与信息。我们调查了基层医疗人员对国民健康服务体系“健康连线”项目中电子健康举措的看法，以及一线工作人员是否准备好实施此类变革。
根据当前计算机使用情况，有目的地挑选了20名来自不同专业组的参与者进行访谈。随后观察了同一批医疗机构工作人员，以便深入了解他们如何使用计算机。
预计会使用新信息技术的医疗机构工作人员（医生、护士、医疗机构管理人员和接待员）以及参与其实施工作的基层医疗信托基金（PCT）工作人员被选入本研究。
伦敦北部一个拥有62家普通诊所的基层医疗信托基金。选取了4家诊所进行研究。
对访谈和观察数据的分析得出了六个反复出现的主题，这些主题与使用信息和通信系统支持临床护理的准备情况相关：对技术和国民健康服务体系“健康连线”的看法；与资源相关的问题；患者选择；与保密和安全相关的事项；政治压力；以及信息技术目前在基层医疗中的使用方式。
在研究开展之时，除质量管理与分析系统（QMAS）外，国民健康服务体系“健康连线”项目的其他系统在整个基层医疗信托基金中并未全面实施。研究中的所有诊所都认可新技术会给工作场所带来的益处，但也存在一些共同担忧，这表明基层医疗诊所的工作人员尚未做好开展电子健康的准备。国民健康服务体系“健康连线”项目的成功实施取决于识别、承认并克服这些担忧。对于那些在使用电子邮件或向电子病历过渡方面进展甚微的诊所，可能需要采取不同的方法。本研究表明，对技术的不信任以及对全面计算机化带来的繁重初始工作量的担忧，使一些诊所不愿接受电子健康。如果国民健康服务体系“健康连线”项目要取得成功，实施团队可能需要首先关注那些一直不愿使用技术来支持临床护理和诊所日常工作的诊所。
