ArticleBMC health services research2012
Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.
Article in BMC health services research, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Evidence-Based Evaluation of eHealth Interventions: Systematic Literature Review.Journal of medical Internet research · 2018Pooled it
- Primary care physicians' attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework.BMC medical informatics and decision making · 2018Pooled it
- The Cultural Politics of 'Implementation Science'.The Journal of medical humanities · 2020Article
- Theoretical and methodological considerations in evaluating large-scale health information technology change programmes.BMC health services research · 2020Review
- Why does the NHS struggle to adopt eHealth innovations? A review of macro, meso and micro factors.BMC health services research · 2019Review
- Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study.BMC medical informatics and decision making · 2019Article
- Using Exploratory Trials to Identify Relevant Contexts and Mechanisms in Complex Electronic Health Interventions: Evaluating the Electronic Patient-Reported Outcome Tool.JMIR formative research · 2019Article
- Drawing on human factors engineering to evaluate the effectiveness of health information technology.Journal of the Royal Society of Medicine · 2017Article
- Building bridges across electronic health record systems through inferred phenotypic topics.Journal of biomedical informatics · 2015Article
- Practice-centred evaluation and the privileging of care in health information technology evaluation.BMC health services research · 2014Article
- Exploring the sociotechnical intersection of patient safety and electronic health record implementation.Journal of the American Medical Informatics Association : JAMIA · 2014Article
- Usability assessment of an electronic health record in a comprehensive dental clinic.SpringerPlus · 2013Article
- A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice.BMC psychiatry · 2013Article
- Improving quality and safety of care using "technovigilance": an ethnographic case study of secondary use of data from an electronic prescribing and decision support system.The Milbank quarterly · 2013Article
- The need for balanced health policies to avoid path dependent medicine.International journal of health policy and management · 2013Article
- We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England.BMC health services research · 2012Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA 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.
methodsCritical 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. SUMMARY: 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.