Using socio-technical thinking to explore the implementation of Electronic Patient Records into NHS secondary care organisations

Background: Electronic Patient Records (EPRs) are being introduced into many healthcare organisations around the world. In the UK, EPRs are seen as one mechanism through which the NHS can become safer and more efficient. The policy and financial support for NHS hospitals to implement these systems, implies a strong evidence base supporting the rationale that electronic records improve health outcomes and quality of care. In reality, there is limited evidence to support this, with a lack of understanding as to the best approaches to and the benefits, barriers and impact of implementing EPRs; particularly within the NHS. In this thesis, the implementation of EPRs into NHS secondary care organisations is explored. Methods: A range of methods were used to explore the implementation of EPRs into NHS secondary care organisations. A policy analysis studied national NHS IT policy documents and evaluations of national NHS IT policy between 1998 and 2015 to investigate whether progress has been made in relation to implementing EPRs into NHS secondary care organisations. A mixed methods approach was adopted to explore the approaches to and challenges and benefits of implementing EPRs in NHS trusts throughout England; this comprised an online survey and semi-structured interviews with chief information officers. Lastly, qualitative interviews explored NHS staffs’ perceptions and experiences of the benefits, barriers and disadvantages of implementing a maternity information system into a single maternity unit. Results: There has been little progress in implementing EPRs in secondary care since 1998, the reasons for which are multifaceted and include a paucity of guidance surrounding the optimum approaches to implementing EPRs with a range of additional social and technical factors. Proposed benefits of EPRs largely related to improved: information availability, accessibility, transfer and legibility; with a limited number of efficiency and patient safety benefits also reported. Conclusions: This thesis adds to a limited UK evidence base and provides a greater understanding of the approaches to and various social and technical factors associated with implementing EPRs into NHS secondary care organisations.