Preparing the ground for the ‘paperless hospital’: A case study of medical records management in a UK outpatient services department
Open accessAbstract
Purpose 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.
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In accordance with existing literature, evidence of actual benefits reported in this study was limited to a number of clinically orientated benefits surrounding improved information availability, accessibility and legibility.
“In accordance with existing literature, evidence of actual benefits reported in our study were limited to a number of ‘clinically orientated’ benefits surrounding improved information availability, accessibility and legibility [19, 23, 31–34].”
From Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory (2017) · cites this paper as [33]
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- Authors
- Waterson, P., Glenn, Y., & Eason, K.
- Affiliations
- Loughborough University (GB)
- Corresponding author
- Waterson, Patrick
- ORCID
- Waterson, Patrick
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 81
- Issue
- 2
- Pages
- 114-129
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2056196745
- Cited by
- 31
- References
- 42
- Citations by year
- 2024: 1 · 2023: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2017: 3 · 2016: 2 · 2015: 7 · 2014: 4 · 2013: 5 · 2012: 2
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.lboro.ac.uk
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health and Care Research
- Loughborough University
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- electronic health records, paperless hospital, medical records management, outpatient care, information system implementation, employee attitudes, end-user involvement, workflow, patient data management, health information technology adoption
- MeSH terms
- Attitude of Health Personnel, Belgium, Cross-Sectional Studies, United Kingdom, Medical Staff, Hospital, Outpatient Clinics, Hospital, Medical Records Systems, Computerized
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