Int J Med Inform - Preparing the ground for the 'paperless hospital': a case study of medical records management in a UK outpatient services department.

Tópicos

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Resumo

RPOSE: The purpose of the study was to understand the preparations for the introduction of electronic patient record systems (EPRs) within the outpatient services department of a large acute hospital based in the UK. In particular, one of the main aims of the study was to examine in detail the likely impact of EPRs on the working practices of healthcare workers, their expectations regarding the impact of EPRs within the department and other sociotechnical aspects of the management of patient information.METHODS: Twenty-seven semi-structured interviews were undertaken with staff in a variety of roles that deal with the management of medical records. The interviews focused on the organisation of the medical records department and current problems (e.g., missing records). In addition, the interviews contained questions about the specific role of medical records supervisors in the administration of records, as well as pathways and expectations about EPRs more generally. The data from the interviews was analysed using a mixture of thematic and template analysis and coded using constructs from a sociotechnical model of information system implementation and adoption.RESULTS: The findings show that despite severe delays to the nationally led (NPfIT) roll-out of EPRs and associated IT infrastructure within the UK, staff attitudes within the department were broadly positive about the potential of future EPRs to deliver efficiencies (e.g., improved workflow within the department, reduced reliance on paper-based systems). One of the main influences on attitudes towards the type of EPRs that should exist within outpatients was prompted by negative reactions to the way in which NPfIT systems had been managed and attempted to be introduced in the past. A strong commitment to end-user involvement in EPRs design, together with a rejection of NPfIT, appears to have shaped attitudes towards future expectations of the adoption of new EPRs within the department. In addition, staff do not believe that a rapid change to 'paperless' working is likely to be possible.CONCLUSIONS: Our findings provide further evidence that there is a need to treat the implementation of EPRs not simply as an exercise in technical system delivery, but as a larger process of sociotechnical systems change. We conclude the paper with some guidelines, the aim of which is to provide guidance regarding EPRs implementation and adoption informed by sociotechnical principles and ideas.

Resumo Limpo

rpose purpos studi understand prepar introduct electron patient record system epr within outpati servic depart larg acut hospit base uk particular one main aim studi examin detail like impact epr work practic healthcar worker expect regard impact epr within depart sociotechn aspect manag patient informationmethod twentyseven semistructur interview undertaken staff varieti role deal manag medic record interview focus organis medic record depart current problem eg miss record addit interview contain question specif role medic record supervisor administr record well pathway expect epr general data interview analys use mixtur themat templat analysi code use construct sociotechn model inform system implement adoptionresult find show despit sever delay nation led npfit rollout epr associ infrastructur within uk staff attitud within depart broad posit potenti futur epr deliv effici eg improv workflow within depart reduc relianc paperbas system one main influenc attitud toward type epr exist within outpati prompt negat reaction way npfit system manag attempt introduc past strong commit endus involv epr design togeth reject npfit appear shape attitud toward futur expect adopt new epr within depart addit staff believ rapid chang paperless work like possibleconclus find provid evid need treat implement epr simpli exercis technic system deliveri larger process sociotechn system chang conclud paper guidelin aim provid guidanc regard epr implement adopt inform sociotechn principl idea

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