Norwegian Centre for E-health Research, P.O. Box 35, N-9038, Tromsø, Norway.
University of Tromsø, The Arctic University of Norway, Hansine Hansens veg 18, N-9019, Tromsø, Norway.
BMC Health Serv Res. 2019 Jul 24;19(1):520. doi: 10.1186/s12913-019-4346-0.
Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives?
Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions.
The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools.
The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.
大型国家电子健康服务，如摘要保健记录（SCR）和电子处方（e-prescriptions），已作为挪威卫生当局的倡议，由项目经理实施。很少有研究关注电子健康服务的大规模实施以及实施者的工作与医疗实践中工具使用之间的关系。因此，需要确定以实践变化为重点的项目工作。本研究从项目经理的角度探讨了 SCR 和电子处方的实施情况；项目经理的实施工作与大型计划中的机构实践有何关系？
2016 年和 2018 年，对 22 名项目经理进行了半结构化访谈，并根据内容进行了记录、转录和编码。使用“项目”和“实践”的分析概念，重点关注将历史上建立的社会实践和现场行动连接起来的时间维度之间的紧张关系。
电子健康倡议被证明是作为国家战略的一部分实施的，并通过与挪威电子健康局（NDE）的密切合作实现的。在项目实施过程中以及之后的日常管理中，出现了与面向任务的行动有关的紧张关系。此外，项目经理的工作任务与工具的传播有关，而在实践中，工具与专业人员的实际使用有关。同时实施多个项目会在工具的实施与特定实践之间以及工具之间产生紧张关系。
项目经理在其工作方面设定的目标应被视为暂时的，而长期目标应适用于工具的使用。因此，实施电子健康倡议的工作可能需要重新定义经验对象。确定影响采用的因素，例如对象的预期用途与现场行动或历史上建立的活动之间的差距，可能会加速未来国家电子健康倡议的成功。机构实践的社会方面直接影响项目成功实施的潜力。
