J A Cleland, D A Cook, S Maloney, M G Tolsgaard
"Important but risky": attitudes of global thought leaders towards cost and value research in health professions education
Advances in health sciences education : theory and practice
describe evaluate implementation adoption detailed electronic health records secondary care england thereby provide early feedback ongoing local national rollout nhs care records servicea mixed methods longitudinal multisite sociotechnical case studyfive nhs acute hospital mental health trusts focus early implementation efforts interim data collection analysis complete data sources analysis dataset evaluation consists semistructured interviews documents field notes observations quantitative data qualitative data analysed thematically sociotechnical coding matrix combined additional themes emerged data main results hospital electronic health record applications developed implemented far slowly originally envisioned topdown standardised approach needed evolve admit variation greater local choice hospital trusts want order support local activity despite considerable delays frustrations support electronic health records remains strong including nhs clinicians political financial factors perceived threaten nationwide implementation electronic health records interviewees identified range consequences long term centrally negotiated contracts deliver nhs care records service secondary care particularly nhs trusts party contracts include convoluted communication channels different stakeholders unrealistic deployment timelines delays applications could quickly respond changing national local nhs priorities data suggest support middleout approach implementing hospital electronic health records combining government direction increased local autonomy restricting detailed electronic health record sharing local health communitiesexperiences early implementation sites received considerable attention financial investment support indicate delivering improved healthcare nationwide electronic health records long complex iterative process requiring flexibility local adaptability respect systems implementation strategy tailored responsive approach emerging becoming better aligned nhs organisations perceived needs pursued likely deliver clinically useful electronic health record systems