Int J Med Inform - The implications of e-health system delivery strategies for integrated healthcare: lessons from England.

Tópicos

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Resumo

RPOSE: This paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care.METHODS: Four technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was conducted in England to examine the human and organizational implications of systems implemented by these four strategies. Results were used from evaluation reports of two systems delivered as part of the NPfIT (National Programme for Information Technology) and from user responses to systems delivered in two local health communities in England. In the latter study 40 clinical respondents reported the use of systems to support integrated care in six healthcare pathways.RESULTS: The implementation of a detailed care record system (DCRS) in the NPfIT was problematic because it could not meet the diverse needs of all healthcare agencies and it required considerable local customization. The programme evolved to allow different systems to be delivered for each local health community. A national Summary Care Record (SCR) was implemented but many concerns were raised about wide access to confidential patient information. The two technical strategies that required looser forms of coupling and were under local control led to wide user adoption. The systems that enabled data to be transferred between local systems were successfully used to support integrated care in specific healthcare pathways. The portal approach gave many users an opportunity to view patient data held on a number of databases and this system evolved over a number of years as a result of requests from the user community.CONCLUSIONS: The UK national strategy to deliver single shared database systems requires tight coupling between many users and has led to poor adoption because of the diverse needs of healthcare agencies. Sharing patient information has been more successful when local systems have been developed to serve particular healthcare pathways or when separate databases are viewable through a portal. On the basis of this evidence technical strategies that permit the local design of tight coupling are necessary if information systems are to support integrated care in healthcare pathways.

Resumo Limpo

rpose paper explor implic differ technic strategi share patient inform healthcar worker consequ extent system provid support integr caremethod four technic strategi identifi form coupl made healthcar agenc classifi studi conduct england examin human organiz implic system implement four strategi result use evalu report two system deliv part npfit nation programm inform technolog user respons system deliv two local health communiti england latter studi clinic respond report use system support integr care six healthcar pathwaysresult implement detail care record system dcrs npfit problemat meet divers need healthcar agenc requir consider local custom programm evolv allow differ system deliv local health communiti nation summari care record scr implement mani concern rais wide access confidenti patient inform two technic strategi requir looser form coupl local control led wide user adopt system enabl data transfer local system success use support integr care specif healthcar pathway portal approach gave mani user opportun view patient data held number databas system evolv number year result request user communityconclus uk nation strategi deliv singl share databas system requir tight coupl mani user led poor adopt divers need healthcar agenc share patient inform success local system develop serv particular healthcar pathway separ databas viewabl portal basi evid technic strategi permit local design tight coupl necessari inform system support integr care healthcar pathway

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