Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland
Abstract
Aim To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries.Method Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory.Main findings Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes.Conclusion When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes.
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Their reservations appeared gradually to lessen as more and more practices joined.
“However, their reservations appeared gradually to lessen as more and more practices joined.”
By the end of 2012, over 40 million of England's 51 million population had been sent a letter about the SCR and over 18 million records had been created, with new records being created at a rate of approximately 1 million per month.
“By the end of 2012, over 40 million of England's 51 million population had been sent a letter about the SCR and over 18 million records had been created, with new records being created at a rate of approximately 1 million per month.”
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- Authors
- Greenhalgh, T., Morris, L., Wyatt, J. C., Thomas, G., & Gunning, K.
- Affiliations
- Queen Mary University of London (GB)
- Scottish Government (GB)
- University of Leeds (GB)
- Welsh Government (GB)
- Health and Social Care Board (GB)
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 82
- Issue
- 5
- Pages
- e125-e138
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2020454829
- Cited by
- 79
- References
- 31
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 11 · 2020: 3 · 2019: 5 · 2018: 10 · 2017: 8 · 2016: 5 · 2015: 9 · 2014: 8 · 2013: 1
- FWCI
- 13.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10031)
- 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 › General Health Professions › Health Services Management and Policy
- Keywords
- electronic health records, national health information systems, emergency care, unscheduled care, health policy implementation, diffusion of innovations, stakeholder engagement, resistance to change, project management, patient confidentiality, cross-national comparison, Scotland, England, Wales, Northern Ireland
- MeSH terms
- Cooperative Behavior, England, Humans, Northern Ireland, Scotland, State Medicine, Wales, Electronic Health Records
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