Division of Health Studies, School of Health Sciences & Social Care, Brunel University, Uxbridge UB8 3PH, UK.
BMC Health Serv Res. 2012 Apr 30;12:105. doi: 10.1186/1472-6963-12-105.
A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money.
Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS).
RESULTS/DISCUSSION: We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions.
New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.
电子健康记录（EHR）系统的承诺现在构成了许多政府医疗改革战略的核心部分。由此产生的由政治发起的大规模或国家 EHR 努力具有挑战性，因为它们具有变革的雄心勃勃议程、使其发挥作用所需的资源规模、设定的（相对）短时间范围以及涉及的大量利益相关者，所有这些都追求略有不同的利益。需要对这些倡议进行评估，以确定它们是否改善了护理并具有物有所值。
根据在英国国家卫生服务保健记录服务（NHS CRS）的实施和采用的首次全国性、纵向和社会技术评估经验，对这些复杂性进行批判性反思。
结果/讨论：我们提出了两个关键论点。首先，EHR 实施的国家计划可能会在不断变化的社会政治和社会技术背景下进行，这些背景很可能会以重大方式塑造它们。这对基于基线操作→干预→变更操作（结果）模型的传统评估方法提出了挑战。其次，此类计划的评估必须通过适应这种不断变化的环境来考虑到这一点。这需要仔细和创造性地选择本体论、认识论和方法论假设。
在评估国家 EHR 实施工作时，面临着新的和重大的挑战。基于对英格兰 NHS CRS 的实施和采用进行的这项国家评估的经验，我们主张对这些评估采取一种方法，这种方法不再将 EHR 系统视为需要以结果为中心的评估的信息和通信技术（ICT）项目，而是采取更具解释性的方法，反映 EHR 在多个特定环境中的具体和不断发展的性质，并反映政策、战略和软件不断变化的环境，以及跨越这些边界的不断互动。
