The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Trisha Greenhalgh - One of the best experts on this subject based on the ideXlab platform.
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introducing a nationally shared Electronic Patient Record case study comparison of scotland england wales and northern ireland
International Journal of Medical Informatics, 2013Co-Authors: Trisha Greenhalgh, Libby Morris, Jeremy C Wyatt, Gwyn Thomas, Katey GunningAbstract:Abstract Aim To compare the experience of the four UK countries in introducing nationally accessible Electronic summaries of Patients’ key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries. Method Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory. Main findings Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which Records were created. A nationally shared, widely accessible Electronic Record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening Patient confidentiality or the traditional role of the doctor or nurse. ‘Hard’ project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the ‘softer’ aspects of the programmes. Conclusion When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of ‘hard’ and ‘soft’ management appears key to managing such programmes.
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never heard of it understanding the public s lack of awareness of a new Electronic Patient Record
Health Expectations, 2010Co-Authors: Tanja Bratan, Katja Stramer, Trisha GreenhalghAbstract:Background The introduction of Electronic Patient Records that are accessible by multiple providers raises security issues and requires informed consent - or at the very least, an opportunity to opt out. Introduction of the Summary Care Record (SCR) (a centrally stored Electronic summary of a Patients medical Record) in pilot sites in the UK was associated with low awareness, despite an intensive public information programme that included letters, posters, leaflets, and road shows. Aim To understand why the public information programme had limited impact and to learn lessons for future programmes. Methods Linguistic and communications analysis of components of the programme, contextualized within a wider mixed-method case study of the introduction of the SCR in pilot sites. Theoretical insights from linguistics and communication studies were applied. Results The context of the SCR pilots and the linked information programme created inherent challenges which were partially but not fully overcome by the efforts of campaigners. Much effort was put into designing the content of a mail merge letter, but less attention was given to its novelty, linguistic style, and rhetorical appeal. Many recipients viewed this letter as junk mail or propaganda and discarded it unread. Other components of the information programme were characterized by low visibility, partly because only restricted areas were participating in the pilot. Relatively little use was made of interpersonal communication channels. Conclusion Despite ethical and legal imperatives, informed consent for the introduction of shared Electronic Records may be difficult to achieve through public information campaigns. Success may be more likely if established principles of effective mass and interper- sonal communication are applied.
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tensions and paradoxes in Electronic Patient Record research a systematic literature review using the meta narrative method
Milbank Quarterly, 2009Co-Authors: Trisha Greenhalgh, Henry W W Potts, Geoff Wong, P Bark, Deborah SwinglehurstAbstract:Background: The extensive and rapidly expanding research literature on Electronic Patient Records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of Electronic Record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research.
Deborah Swinglehurst - One of the best experts on this subject based on the ideXlab platform.
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displays of authority in the clinical consultation a linguistic ethnographic study of the Electronic Patient Record
Social Science & Medicine, 2014Co-Authors: Deborah SwinglehurstAbstract:The introduction of computers into general practice settings has profoundly changed the dynamics of the clinical consultation. Previous research exploring the impact of the computer (in what has been termed the ‘triadic’ consultation) has shown that computer use and communication between doctor and Patient are intricately coordinated and inseparable. Swinglehurst et al. have recently been critical of the ongoing tendency within health communication research to focus on ‘the computer’ as a relatively simple ‘black box’, or as a material presence in the consultation. By re-focussing on the Electronic Patient Record (EPR) and conceptualising this as a complex collection of silent but consequential voices, they have opened up new and more nuanced possibilities for analysis. This orientation makes visible a tension between the immediate contingencies of the interaction as it unfolds moment-by-moment and the more standardised, institutional demands which are embedded in the EPR (‘dilemma of attention’). In this paper I extend this work, presenting an in-depth examination of how participants in the consultation manage this tension. I used linguistic ethnographic methods to study 54 video Recorded consultations from a dataset collected between 2007 and 2008 in two UK general practices, combining microanalysis of the consultation with ethnographic attention to the wider organisational and institutional context. My analysis draws on the theoretical work of Erving Goffman and Mikhail Bakhtin, incorporating attention to the ‘here and now’ of the interaction as well as an appreciation of the ‘distributed’ nature of the EPR, its role in hosting and circulating new voices, and in mediating participants' talk and social practices. It reveals – in apparently fleeting moments of negotiation and contestation – the extent to which the EPR shapes the dynamic construction, display and circulation of authority in the contemporary consultation.
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opening up the black box of the Electronic Patient Record a linguistic ethnographic study in general practice
Communication in medicine, 2011Co-Authors: Deborah Swinglehurst, Celia Roberts, Tricia GreenhalghAbstract:One of the most pervasive changes in general practice is the introduction of the Electronic Patient Record (EPR). The EPR supports both immediate clinical and anticipatory care (e.g. management of risk factors). Incorporating the EPR into social interaction is a complex task which is achieved discursively, clinician and Patient responding to interactional contingencies as the consultation unfolds. Clinicians are presented with a 'dilemma of attention' as they seek to deal with the immediacy ('here and now') of the interpersonal interaction and the institutional demands ('there and then') of the EPR. We present data analysis which illuminates the EPR as an important presence in the clinic consultation context, one which places material and textual demands. Developing previous work on the triadic (three party) consultation, our novel multimodal analysis of the EPR-in-use suggests there is value in considering the EPR as a collection of silent but consequential voices. Micro-analytic attention to the way in which these different voices are managed, combined with understandings drawn from ethnographic observation of the primary care context, reveals the EPR as exhibiting a previously under-explored kind of 'agency' within the consultation.
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tensions and paradoxes in Electronic Patient Record research a systematic literature review using the meta narrative method
Milbank Quarterly, 2009Co-Authors: Trisha Greenhalgh, Henry W W Potts, Geoff Wong, P Bark, Deborah SwinglehurstAbstract:Background: The extensive and rapidly expanding research literature on Electronic Patient Records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of Electronic Record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research.
Brent J Liu - One of the best experts on this subject based on the ideXlab platform.
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dicom rt and its utilization in radiation therapy
Radiographics, 2009Co-Authors: Maria Y Y Law, Brent J LiuAbstract:The Digital Imaging and Communications in Medicine (DICOM) standard is now widely implemented in radiology as the standard for diagnostic imaging. It has also been extended for use in various sub-specialties. One of the first extensions was applied to radiation therapy and is known as DICOM-RT. In addition to the protocol used in the DICOM standard, seven DICOM-RT objects—namely, RT Image, RT Structure Set, RT Plan, RT Dose, RT Beams Treatment Record, RT Brachy Treatment Record, and RT Treatment Summary Record—have been created, each with a well-defined data model. The data models set the standard for integration of radiation therapy information for an Electronic Patient Record and would facilitate the interoperability of different radiation therapy systems, thus making possible the sharing of information from different systems. © RSNA, 2009
Maria Y Y Law - One of the best experts on this subject based on the ideXlab platform.
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dicom rt and its utilization in radiation therapy
Radiographics, 2009Co-Authors: Maria Y Y Law, Brent J LiuAbstract:The Digital Imaging and Communications in Medicine (DICOM) standard is now widely implemented in radiology as the standard for diagnostic imaging. It has also been extended for use in various sub-specialties. One of the first extensions was applied to radiation therapy and is known as DICOM-RT. In addition to the protocol used in the DICOM standard, seven DICOM-RT objects—namely, RT Image, RT Structure Set, RT Plan, RT Dose, RT Beams Treatment Record, RT Brachy Treatment Record, and RT Treatment Summary Record—have been created, each with a well-defined data model. The data models set the standard for integration of radiation therapy information for an Electronic Patient Record and would facilitate the interoperability of different radiation therapy systems, thus making possible the sharing of information from different systems. © RSNA, 2009
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informatics in radiology dicom rt based Electronic Patient Record information system for
2009Co-Authors: Maria Y Y Law, W ChaAbstract:Comprehensive clinical imaging data and additional relevant information are crucial for the planning and delivery of radiation therapy in Patients with cancer. Multiple stand-alone systems that make use of technologic advances in imaging, treatment planning, and treatment delivery acquire or generate key data during the course of radiation therapy. However, the data are scattered in various systems throughout the radiation therapy department, thereby compromising effi cient clinical work flow. In 1997 and 1999, the Digital Imaging and Communications in Medicine (DICOM) standard was extended from radiology to radiation therapy with the ratification of seven DICOMRT objects. These objects helped set the standard for (a) data integration and interoperability between radiation therapy equipment and information systems from different manufacturers, and (b) the use of DICOM diagnostic images in radiation therapy. More recently, key radiation therapy imaging and informatics data have been integrated to form an open-architecture comprehensive radiation therapy Electronic Patient Record (ePR) system. The benefits of such a DICOMRT–based ePR system are threefold: it can be used as a foundation for performing effective and efficient clinical services, as a common platform for radiation therapy data exchange and expert consultation, and for medical imaging informatics research in developing innovative decision support tools and a knowledge base for improved treatment with radiation therapy.
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a model of dicom based Electronic Patient Record in radiation therapy
Computerized Medical Imaging and Graphics, 2005Co-Authors: Maria Y Y LawAbstract:Electronic Patient Records for radiation therapy (RT) consists of text, images and graphics. To enable the exchange of RT Patient information between systems and institutions, a common standard is called for and the DICOM standard extension to radiation therapy is an appropriate means for standardization. This paper describes a model of DICOM-based Electronic Patient Record system for information exchange and sharing. The system used a DICOM-based RT archive server as a common platform for archival of all RT related information including images and the web technology for distribution and viewing of the Patient Electronic Record.
Jurgen Stausberg - One of the best experts on this subject based on the ideXlab platform.
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methodological review value of the Electronic Patient Record an analysis of the literature
Journal of Biomedical Informatics, 2008Co-Authors: Aykut Uslu, Jurgen StausbergAbstract:We undertook a systematic review of the literature on the basis of published studies on the benefit and costs of Electronic Patient Records (EPRs) to clarify the issue of whether and to what extent the use of an EPR is worthwhile. We carried out a systematic Electronic search for articles published between 1966 and early 2004 using MEDLINE, following up cross-references from the articles found. We searched first for suitable medical subject headings (MeSH) for Electronic Patient Record, benefit and costs. We obtained 7860 citations with the MeSH keyword ''Medical Record System, Computerized''. After combination with appropriate keywords this number was reduced to 588, after a review by two reviewers independently based on abstracts down to 95, and after a further review based on full-text articles to 19 covering 20 studies. The publications evaluated thus document the economic benefits of EPR in a number of areas, but they do not make a statement of the cost effectiveness of EPR in general.
