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Cited by 276Electronic Health Records SystemsMedical Coding and Health InformationInformation Systems Theories and Implementation

The DOI matches its Crossref record; 43 of the 44 references it cites were found in a registry or an index.

Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

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Greenhalgh, T., Stramer, K., Bratan, T., Byrne, E., Russell, J., Potts, H. W. W.·2010·BMJ
DOI 10.1136/bmj.c3111
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Abstract

OBJECTIVE: To evaluate a national programme to develop and implement centrally stored electronic summaries of patients' medical records. DESIGN: Mixed-method, multilevel case study. SETTING: English National Health Service 2007-10. The summary care record (SCR) was introduced as part of the National Programme for Information Technology. This evaluation of the SCR considered it in the context of national policy and its frontline implementation and use in three districts. Participants and methods Quantitative data (cumulative records created nationally plus a dataset of 416 325 encounters in participating primary care out-of-hours and walk-in centres) were analysed statistically. Qualitative data (140 interviews including policy makers, managers, clinicians, and software suppliers; 2000 pages of ethnographic field notes including observation of 214 clinical consultations; and 3000 pages of documents) were analysed thematically and interpretively. RESULTS: Creating individual SCRs and supporting their adoption and use was a complex, technically challenging, and labour intensive process that occurred more slowly than planned. By early 2010, 1.5 million such records had been created. In participating primary care out-of-hours and walk-in centres, an SCR was accessed in 4% of all encounters and in 21% of encounters where one was available; these figures were rising in some but not all sites. The main determinant of SCR access was the identity of the clinician: individual clinicians accessed available SCRs between 0 and 84% of the time. When accessed, an SCR seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a rare but important positive impact on preventing medication errors. SCRs sometimes contained incomplete or inaccurate data, but clinicians drew judiciously on these data along with other sources. SCR use was not associated with shorter consultations or reduction in onward referral. Successful introduction of SCRs depended on interaction between multiple stakeholders from different worlds (clinical, political, technical, commercial) with different values, priorities, and ways of working. The programme's fortunes seemed to turn on the ability of change agents to bridge these different institutional worlds, align their conflicting logics, and mobilise implementation effort. CONCLUSIONS: Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.

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Research works printed but not linked: 5

  1. Darling A. Modern public services for Britain: investing in reform. Comprehensive spending review: new public spending plans 1999- 2002. HM Treasury, 1998.
  2. Department of Health. The NHS informatics review report. The Stationery Office, 2008.
  3. Darzi A. High quality health for all: NHS Next Stage Review Final Report. The Stationery Office, 2008.
  4. Darling A. Comprehensive spending review. HM Treasury, 1998.
  5. BMA Press Office. BMA calls for roll-out of electronic patient records to be suspended. Press release, 10 March 2010. British Medical Association, 2010.

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Metadata

Authors
Greenhalgh, T., Stramer, K., Bratan, T., Byrne, E., Russell, J., & Potts, H. W. W.
Affiliations
  • Queen Mary University of London (GB)
  • University College London (GB)
Corresponding author
Greenhalgh, T.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2010-06-16
Volume
340
Issue
jun16 4
Pages
c3111-c3111
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.c3111
OpenAlex
W2093551211
Cited by
275
References
44
Citations by year
2026: 8 · 2025: 27 · 2024: 8 · 2023: 7 · 2022: 10 · 2021: 5 · 2020: 12 · 2019: 12 · 2018: 13 · 2017: 13 · 2016: 20 · 2015: 16 · 2014: 29 · 2013: 30 · 2012: 22
FWCI
55.46
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Information Systems Theories and Implementation
Keywords
Summary Care Record, electronic health records, health information technology adoption, walk-in centres, medication errors, quality of care, stakeholder interaction, change agents, health policy evaluation
MeSH terms
Data Collection, England, Humans, Program Evaluation, Medical Records Systems, Computerized, Qualitative Research, Clinical Governance

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