Modelling nursing activities: electronic patient records and their discontents

Goorman, Els; Berg, Marc

doi:10.1046/j.1440-1800.2000.00053.x

Cited by 87 publications

(62 citation statements)

References 23 publications

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“…Nurs Inq 2000;7:3-9 235 What this means is that the generation, endorsement and dissemination of SOPs (a tangible achievement of this study) will not, in and of itself, make virtual consultations happen. Attention also needs to be paid to the messy reality of implementing these standards, in particular, in 'imperfect' real-world settings.…”

Section: Discussionmentioning

confidence: 96%

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

Shaw

Wherton

Vijayaraghavan

et al. 2018

Health Serv Deliv Res

148

186

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 13/59/26. The contractual start date was in March 2015. The final report began editorial review in July 2017 and was accepted for publication in November 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Depar...

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Section: Discussionmentioning

confidence: 96%

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

Shaw

Wherton

Vijayaraghavan

et al. 2018

Health Serv Deliv Res

148

186

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“…Using an animator we were able to get respondents to discuss their concerns and other relevant issues in their own terms without (or at least to a lesser degree) alienating them from their own working practices and understanding of their everyday experiences. 11 Using the animator as a stimulus in focus groups we tapped into the lay understanding of users, grounded the themes from their comments, and began to see how these themes fitted into the more abstract discourses surrounding the policy and technical discourses around EHR.…”

Section: Discussionmentioning

confidence: 99%

“…6,[9][10][11] Findings from medical records research have shown that there is a need for users to have an opportunity to adopt the EPR and influence its development. [12][13][14] A key issue is eliciting user involvement across a range of stakeholders, the absence of which has been identified as a cause of system failure in the past.…”

Section: Introductionmentioning

confidence: 99%

The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools

Woodward¹,

Wilson²

2007

Journal of Innovation in Health Informatics

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IntroductionThis paper describes the deployment of a prototype demonstration tool aimed at facilitating users' engagement with the design, development and implementation of EHRs. It is not a prototype of an EHR system; rather it is aimed at engaging potential users at the conceptualisation stage; it aims to tap into members' knowledge that will be useful throughout the design, development and implementation process. Neither is it intended to replace the use of prototype systems and other user engagement techniques; it is ABSTRACT Background and aim To investigate the use of animation tools to aid visualisation of problems for discussion within focus groups, in the context of healthcare workers discussing electronic health records (EHRs). Method Ten healthcare staff focus groups, held in a range of organisational contexts. Each focus group was in four stages: baseline discussion, animator presentation, post-animator discussion and questionnaire. Audio recordings of the focus groups were transcribed and coded and the emergent analytic themes analysed for issues relating to EHR design and implementation. The data allowed a comparison of baseline and post-animator discussion. Results The animator facilitated discussion about EHR issues and these were thematically coded as:

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“…Goorman and Berg point out the danger of modelling new technologies based on an idealised model of how work should be done rather than recognising that although real life often appears complex, healthcare work is usually pragmatic. 18 'Practical rationality' , as they would term the cautious response of the nurses, 'can only be overlooked at a high price (i.e. system failure)' .…”

Section: Discussionmentioning

confidence: 99%

Lessons from the implementation of a near patient anticoagulant monitoring service in primary care

Lusignan

Singleton²,

Wells³

2004

Journal of Innovation in Health Informatics

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Objective To evaluate the implementation of a primary care, nurse-led, near patient anticoagulant monitoring service. Design Action research workshops, supported by questionnaires and clinical audit, to define the strengths and weaknesses of the service and the effectiveness of the computerised decision support system used to set the dosage of anticoagulant and time interval to the next appointment. Setting 13 general practices that implemented anticoagulant monitoring in a primary care organisation in south east England. Participants 18 practice nurses, 72% of whom had over 20 years' clinical experience; the universitybased investigators and managers from the primary care organisation. Main outcome measure The nurses felt that the patients preferred the practice-based service, finding it more personal and accessible. However, circumstances arose where the nurse's intuition had to override the software's advice. The nurses found it stressful when they were unclear whether their decision making represented acceptable variation or dangerous practice. An audit tool was developed to measure the extent to which there was variation from the software's recommendation, and patterns of variation emerged. Most evident was that nurses responded to uncertainty by practising cautiously, shortening the interval until the next visit and slightly reducing the recommended dose of warfarin. Conclusions The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software's recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care.Keywords (MeSH terms): anticoagulants, computerassisted, decision making, family practice, medical informatics, medical informatics applications, warfarin S de Lusignan, A Singleton and S Wells 28 Near patient testing allows monitoring to be provided outside the hospital setting. Traditionally patients had to travel to the local hospital for testing, where junior doctors adjusted their warfarin dose without the benefit of CDSS. 6,7 The combination of near patient testing and CDSS allows warfarin testing to take place in local clinics or in patients' homes, with the service provided by nurses or other non-medical staff. Where comparison has been made between nurses using computerised decision support and junior doctors using clinical judgement, the nurses achieved better control for patients with an INR target ratio of 2-3, and as good control as the doctors when target INR is 3-4.5. 8 A primary care organisation (PCO) recognised the potential benefits of a practice-based anticoagulation service and implemented it across 13 practices, deciding that practice nurses would be the appropriate professional group to deliver the service. They put on a training course comprising the relevant biomedicine: how anticoagulants work, the patients who need it and for how long, interactions and safety issues. The p...

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Modelling nursing activities: electronic patient records and their discontents

Cited by 87 publications

References 23 publications

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools

Lessons from the implementation of a near patient anticoagulant monitoring service in primary care

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