Medical and Nursing Staff Perspectives on an Electronic Health Record Implementation in Hospital Outpatient Departments - A Qualitative Study in Four English Hospital Trusts

Kate Marsden, Tony Avery, Sarah P. Slight, Nicholas Barber

2013

Abstract

Objective: The authors sought to investigate the attitude of the staff using computers in outpatient departments and whether their perceptions altered as a result of the NHS Care Record Service (CRS) implementation. Design: Qualitative study using semi-structured interviews and observations. Participants: A total of 70 interviews were undertaken representing a broad range of staff involved in the outpatient department including doctors, nurses, managers, medical records staff, clerks and IT staff. In addition, 361 hours of observations were carried out in the outpatient departments over a six week period. Setting: UK Results: This study highlighted the dependence that outpatient department staff placed on IT and the complexity of issues surrounding their use of computer systems. All outpatient staff used a computer to some degree in their work and were relatively computer literate but recognised that there were problems with the technology such as the length of time it took to get information from the system, the number of times it crashed and the lack of interoperability between different systems. The implementation of the NHS in one trust created additional problems for the outpatient staff, especially during the rather protracted bedding-in time. As the software was more complex than the previous system, it required a greater number of clicks to find the information needed. The added scale and complexity of the NHS CRS was perceived to have resulted in an overall slower system, with problems finding relevant patient information on the screen. The clinic booking system configuration created difficulties with double or triple booking of clinics or clinics cancelled. During this process, staff did not feel that senior managers were listening to their concerns. Conclusions: The outpatient department has different and unique requirements which must be considered during the development stage of any new electronic health record system. IT development processes must acknowledge that new software systems require a degree of maturity and undergo testing in the different departments prior to the implementation process. Staff need to feel part of the software implementation process and their problems addressed to reduce stress and anxiety. The software design flaws described decreased the acceptance of the NHS CRS by staff but it is important to recognise that staff opinions and views may change over time as the system becomes embedded and matures.

References

  1. Audit Commission (2010). More for Less 2009/10: Are efficiency and productivity improving in the NHS? London, Audit Commisison.
  2. Bazeley, P. (2007). Qualitative data analysis with NVivo. London, Sage.
  3. Boonstra, A. and M. Broekhuis (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res 10: 231.
  4. Buntin, M. B., M. F. Burke, et al. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Information Technology 30(3): 464-471.
  5. Cresswell, K., M. Ali, et al. (2011). The Long and Winding Road…An Independent Evaluation of the Implementation and Adoption of the National Health Service Care Records Service (NHS CRS) in Secondary Care in England. [online] Available at http://www.haps.bham.ac.uk/publichealth/cfhep/005.s html [Accessed 27 September 2011].
  6. Cresswell, K. M., A. Worth, et al. (2012). Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak 12.
  7. Dillon, T. W., R. Blankenship, et al. (2005). Nursing attitudes and images of electronic patient record systems. Cin-Computers Informatics Nursing 23(3): 139-145.
  8. Firth, L. A., D. J. Mellor, et al. (2008). The negative impact on nurses of lack of alignment of information systems with public hospital strategic goals. Australian Health Review 32(4): 733-733-739.
  9. Holden, R. J. (2009). Beliefs about health information technology: An investigation of hospital physicians' beliefs about and experiences with using electronic medical records. PhD, The University of Wisconsin [Accessed 1 September 2011]
  10. Jensen, T. B. and M. Aanestad (2007). How Healthcare Professionals Make Sense of an Electronic Patient Record Adoption. Information Systems Management 24(1): 29-29-42.
  11. Joos, D., Q. Chen, et al. (2006). An electronic medical record in Primary Care: impact on satisfaction, work, efficiency and clinical processes. AMIA Annual Symposium 2006 394-398.
  12. Kossman, S. P. (2006). Perceptions of impact of electronic health records on nurses' work. Consumer-Centered Computer-Suppported Care for Healthy People. H. A. M. P. D. C. Park. 122: 337-341.
  13. Miller, R. H. and I. Sim (2004). Physicians' Use Of Electronic Medical Records: Barriers And Solutions. Health Affairs 23(2): 116-116-126.
  14. Moody, L. E., E. Slocumb, et al. (2004). Electronic health records documentation in nursing - Nurses' perceptions, attitudes, and preferences. Cin-Computers Informatics Nursing 22(6): 337-344.
  15. Robertson, A., D. Bates, et al. (2011 Nov). The rise and fall of England's National Programme for IT. J R Soc Med. 104(11): 434-435.
  16. Robertson, A., T. Cornford, et al. (2012). The NHS IT project: more than just a bad dream. The Lancet 379(9810): 29-30.
  17. Robertson, A., K. Cresswell, et al. (2010). Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ 341.
  18. Scott, J. T., T. G. Rundall, et al. (2005). Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study. BMJ 331(3 December 2005).
  19. Sheikh, A., T. Cornford, et al. (2011). Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ 343.
  20. Whittaker, A. A., M. Aufdenkamp, et al. (2009). Barriers and facilitators to electronic documentation in a rural hospital. Journal of Nursing Scholarship 41(3): 293- 300.
Download


Paper Citation


in Harvard Style

Marsden K., Avery T., P. Slight S. and Barber N. (2013). Medical and Nursing Staff Perspectives on an Electronic Health Record Implementation in Hospital Outpatient Departments - A Qualitative Study in Four English Hospital Trusts . In Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013) ISBN 978-989-8565-37-2, pages 394-398. DOI: 10.5220/0004321803940398


in Bibtex Style

@conference{healthinf13,
author={Kate Marsden and Tony Avery and Sarah P. Slight and Nicholas Barber},
title={Medical and Nursing Staff Perspectives on an Electronic Health Record Implementation in Hospital Outpatient Departments - A Qualitative Study in Four English Hospital Trusts},
booktitle={Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013)},
year={2013},
pages={394-398},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0004321803940398},
isbn={978-989-8565-37-2},
}


in EndNote Style

TY - CONF
JO - Proceedings of the International Conference on Health Informatics - Volume 1: HEALTHINF, (BIOSTEC 2013)
TI - Medical and Nursing Staff Perspectives on an Electronic Health Record Implementation in Hospital Outpatient Departments - A Qualitative Study in Four English Hospital Trusts
SN - 978-989-8565-37-2
AU - Marsden K.
AU - Avery T.
AU - P. Slight S.
AU - Barber N.
PY - 2013
SP - 394
EP - 398
DO - 10.5220/0004321803940398