EPICOg - The use of electronic patient record systems across organisational boundaries.
This four-year study examined the progress and problems of using e-health patient record systems in two local health communities to support the 'seamless care' of patients as they move along healthcare pathways and between different health agencies. This project was funded by the NIHR SDO (now HS&DR) programme and the Institute worked with colleagues in Staffordshire and Loughborough Universities. Rather than focus on the impact of a specific technical system, as is usual, the project focused on collective healthcare tasks (as found in healthcare pathways such as the Stroke Pathway). It evaluated the contribution that a number of e-health systems made to coordinated care in the performance of these tasks. The results show that whilst shared access to electronic records can be of great benefit in supporting coordinated care, at present sharing is limited by many organisational and technical problems. Where there were e-health systems that supported pathways they were designed for management purposes and often failed to support ‘handovers’ and other coordination needs of front line staff.
The relationship between researchers and users
The ESRC commissioned a study of the relationship between researchers and users in its programme “The Nation’s Diet”. Fifteen of the sixteen projects were studied; seven of them were used as case studies to provide thumb-nail sketches of various trajectories, the route taken by a piece of research along its way to outcomes, impact and influence. However, the concept of "trajectories" implies that the work starts at the point where a grant is awarded. But its antecedents are also important: some researchers had pre-existing relationships with professionals who could be considered users, or with members of potential user organisations, some began to set up such relationships when they knew they were getting the grant. The research then had a ready audience or could become a collaborative effort from early stages. Others did not consider such relationships until the work was done, and could then be frustrated in their efforts to make them. Moreover, relations between the parties was not the same thing as utilisation or impact of the researches.
Some factors influencing user engagement were:
- The discipline and the type of data it produces. In some disciplines the data do not yield findings until aggregated, in some an individual case study can be used to point an issue. Sone findings are not directly applicable for a user, they serve to unpick or differentiate a subject; their users are other researchers.
- Time aspects. Some types of finding are immediately useable, some need a long process of digestion or to be combined with others before their meaning becomes clear, or replication before one is confident.
- The antecedents of the project: Engagement was more likely where there were pre-existing institutional or personal links: with user professionals, with administrators in user organisations such as government departments, with researchers in user organisations
- The orientation and values of the researcher: In some projects the trajectory was towards further research and did not involve users. Conversely, in one project an element of user engagement was built into the research design
- The nature of the resarch topic: Two of the studies were mainly concerned with secondary analysis of existing data. Nearly all the others in differfent ways studied various populations. The researchers had to deal with the issue of their own detachment or commitment, and this in turn affected their attitude towards dissemination. One linked up with a supermarket to run health clubs for a particular population.
- The context of research careers: Some researchers stay within a subject area, accumulating expertise, while others move on to other topics and leave the subject area behind.
- The institutional context: One location had a Centre for running short courses and workshops, to which workshops on a new topic could be added. Two had access to the teaching and training of doctors, two others also had teaching access to gatekeeper professionals.
Junior doctors and the hospital computer information system
This study was commissioned by the Department of Health as a spin-off from the larger EPR evaluation programme. Junior doctors move from one hospital to another, and so were in a good position to compare and contrast experiences with and without the system. Much of their work uses the computer, so they have a lot of experience to reflect on.
First, in-depth interviews were conducted with five house officers and one registrar, comparing experiences "with" the conputer system to subsequent experiences "without" it. A second phase sought input from larger numbers and included interviews with senior house officers (SHOs) as well as house officers (HOs) revealing different patterns of experiences. In addition to the house officers'move from "with" to "without", SHOs had earlier experiences at hospitals "without" before moving to the "with" hospitals.
Springfield Hospital Regeneration Programme
The South West London and St George's Mental Health NHS Trust was planning a major regeneration programme for its Springfield Hospital site. As part of the preparation for this, we carried out a study of senior staff attitudes towards the programme.
Patients' choices and expectations in obtaining primary care
In 2010 the Garway Medical Practice in Bayswater received a grant from the then Westminster PCT's Innovation Fund to study patient population movement and registration and de-registration in the area. The original title was: "Bayswater & Paddington population migration and registration patterns analysis". The presenting problem was that, as a result of relocation to new premises and the attendant turbulence, their patient list had shrunk substantially. The project therefore had twin purposes:
- To gain better understanding of patients' registration patterns as well as their use of unscheduled care settings·
- To help increase the number of patients registering at the Garway Medical Practice, while providing a case study which might be of use to other GP Practices
The project turned out in many ways to be a microcosm of the current NHS:
- There was a constant tension at the intersection between understanding the context of policies, regulations, poltical and economic considerations, institutions and professional roles on the one hand, and identifying with the experience of the individual patient on the other.
- It was difficult to focus on the primary task because of turbulence in the environment
The problems encountered were themselves a source of learning: the original focus was modified and, with the support of a representative Steering Group, some findings and recommendations both for the Practice and at a broader level were presented.
We joined Loughborough University Business School in a study for the Department of Trade and Industry of computer security breaches caused by company employees. We investigated examples of employee behaviour that led to significant problems for companies, e.g. doctors who mislaid memory sticks containing the medical records of patients. The study demonstrated that complex and abstruse computer security procedures could become counter-productive: when employees had difficulty following procedures or memorising passwords they resorted to workarounds that carried risks for the security of the information held in company systems.