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As governments commit to national electronic health record (EHR) systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes – 'top-down', 'bottom-up' and 'middle-out' – to review EHR implementation strategies in three exemplar countries: England, the USA and(More)
OBJECTIVES To evaluate the implementation and adoption of the NHS detailed care records service in "early adopter" hospitals in England. DESIGN Theoretically informed, longitudinal qualitative evaluation based on case studies. SETTING 12 "early adopter" NHS acute hospitals and specialist care settings studied over two and a half years. DATA SOURCES(More)
OBJECTIVES To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. DESIGN A mixed methods, longitudinal, multisite, socio-technical case study. SETTING Five NHS acute hospital(More)
BACKGROUND Patient histories in electronic health records currently exist mainly in free text format thereby limiting the possibility that decision support technology may contribute to the accuracy and timeliness of clinical diagnoses. Structuring and/or coding make patient histories potentially computable. METHODS A systematic review was undertaken of(More)
BACKGROUND Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood. AIMS AND OBJECTIVES We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health(More)
OBJECTIVE To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals. MATERIALS AND METHODS In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had(More)
BACKGROUND The absence of meaningful end user engagement has repeatedly been highlighted as a key factor contributing to 'failed' implementations of electronic health records (EHRs), but achieving this is particularly challenging in the context of national scale initiatives. In 2002, the National Health Service (NHS) embarked on a so-called 'top-down'(More)
OBJECTIVE We aimed to explore stakeholder views, attitudes, needs, and expectations regarding likely benefits and risks resulting from increased structuring and coding of clinical information within electronic health records (EHRs). MATERIALS AND METHODS Qualitative investigation in primary and secondary care and research settings throughout the UK. Data(More)