eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG.
BMJ. 2010 Sep 1;341:c4564. doi: 10.1136/bmj.c4564.
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.
A mixed methods, longitudinal, multisite, socio-technical case study.
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.
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.
描述和评估英国二级保健中详细电子健康记录的实施和采用情况，从而为正在进行的国民保健服务（NHS）保健记录服务的本地和国家推广提供早期反馈。
混合方法、纵向、多地点、社会技术案例研究。
五个NHS 急性医院和心理健康信托机构，这些机构是早期实施工作的重点，并且已经完成了中期数据收集和分析。
评估数据集包括半结构化访谈、文件和现场记录、观察和定量数据。定性数据采用社会技术编码矩阵进行主题分析，并结合数据中出现的其他主题。
医院电子健康记录应用程序的开发和实施速度远远慢于最初的设想；自上而下的标准化方法需要演变，以允许更多的变化和更大的本地选择，这是医院信托机构为了支持本地活动所需要的。尽管存在相当大的延迟和挫折，对电子健康记录的支持仍然很强，包括 NHS 临床医生的支持。政治和财政因素现在被认为威胁到全国范围内电子健康记录的实施。
受访者确定了长期、中央协商合同在二级保健中提供 NHS 保健记录服务的一系列后果，特别是因为 NHS 信托机构本身不是这些合同的一方。这包括不同利益相关者之间复杂的沟通渠道、不切实际的部署时间表、延迟以及无法快速响应国家和地方 NHS 优先事项变化的应用程序。我们的数据表明，支持一种“自下而上”的方法来实施医院电子健康记录，将政府的指导与增加的地方自主权相结合，并将详细的电子健康记录共享限制在当地卫生社区。
从早期实施地点获得的经验，这些地点受到了相当大的关注、财务投资和支持，表明通过全国范围内的电子健康记录来改善医疗保健将是一个漫长、复杂和迭代的过程，这需要在系统和实施策略方面都具有灵活性和本地适应性。正在出现的更具针对性、响应性的方法越来越符合 NHS 组织的需求，如果推行，可能会提供临床有用的电子健康记录系统。
