Int J Med Inform - Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland.

Tópicos

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Resumo

M: To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries.METHOD: Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory.MAIN FINDINGS: Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes.CONCLUSION: When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes.

Resumo Limpo

m compar experi four uk countri introduc nation access electron summari patient key medic detail intend use emerg unschedul care episod generat transfer lesson countriesmethod secondari analysi data collect previous four scheme crosscas comparison use framework deriv diffus innov theorymain find whilst four programm share similar vision differ wide strategi budget implement plan approach clinic public engag approach evalu learn also differ various reason stakehold align natur extent resist programm rate record creat nation share wide access electron record power symbol mean may may perceiv improv qualiti safeti care altern threaten patient confidenti tradit role doctor nurs hard project manag orient achiev specif mileston deadlin sometim appear counterproduct cut across softer aspect programmesconclus design implement complex technolog pervas implic policymak must consid technic issu also person social organis aspect programm judici blend hard soft manag appear key manag programm

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