Pagliari C et al. 2004 "Electronic Clinical Communications Implementation (ECCI) in Scotland: a mixed-methods programme evaluation."
Reference
Pagliari C, Gilmour M, Sullivan F. Electronic Clinical Communications Implementation (ECCI) in Scotland: a mixed-methods programme evaluation. J Eval Clin Pract 2004;10(1):11-20.
Abstract
"Aims The Electronic Clinical Communications Implementation programme aims to facilitate implementation of electronic systems for primary-secondary care communication, focusing on laboratory results reporting, outpatient appointment booking, referral, discharge and clinic correspondence, and clinical e-mail. This independent programme evaluation explored the processes and outcomes of implementation, barriers and facilitators to system adoption, and benefits and drawbacks for professional users. Methods The mixed methods approach incorporated document review, surveys, stakeholder interviews, consensus exercises, and monthly recording of quantitative process and outcome variables. Results Qualitative and survey work highlighted wide variation in the technologies and implementation approaches adopted. A consensus process was used to instigate a national minimum dataset. To date, implementation of laboratory results reporting has demonstrated the greatest success and electronic outpatient booking the least. A mixed-format survey of users in clinical practice revealed a more detailed picture of behaviour and attitudes demonstrating that where systems are available and accepted they are utilized, while product usability, process complexity and user-engagement methods influence uptake. Conclusions The evaluation has demonstrated the difficulties faced when attempting to implement a multifaceted technological and behavioural change intervention on a national scale, but has also revealed unexpected benefits, including general improvements in Information Management & Technology capability across the Scottish health service."
Objective
"To facilitate implementation of electronic systems for primary-secondary care communication, focusing on laboratory results reporting, outpatient appointment booking, referral, discharge and clinic correspondence, and clinical e-mail."
Type Clinic
Primary care and specialty care
Size
Small, medium and large
Geography
Urban and suburban
Other Information
Various technologies were implemented across Scotland to meet the project goals.
Type of Health IT
Electronic data transmission
Type of Health IT Functions
The system "targets six electronic deliverables relating to direct hospital outpatient appointment booking from primary care, referral from primary to secondary care, results reporting from secondary care laboratories to primary care, transfer of hospital discharge and clinic letters to primary care and clinical e-mail (e.g., second opinion correspondence)."
Workflow-Related Findings
In sites where the technologies were available, the vast majority of clinical communications were sent via electronic means. Results reporting was performed electronically (92 percent by general practioner (GPs), 79 percent by nurses, and 81 percent by administrative staff), discharge letters were received electronically (66 percent by GPs, 31 percent by nurses, and 62 percent by administrative staff), referrals were sent electronically (82 percent by GPs, 29 percent by nurses, and 62 percent by administrative staff) and outpatient appointment booking was performed electronically (69 percent by GPs, 26 percent by nurses, and 52 percent by administrative staff). "Lower usage by nurses reflects their lesser access to desktop computers."
"No site reported using [all of the technology types] and most reported using only one or two."
"Benefits and drawbacks were identified. For example, 'more efficient referrals,' 'quicker access to lab results', 'being able to ask for a consultant's advice via email,' 'being able to download discharge letter into patient's computer log' vs. 'takes too long,' 'can be unreliable,' 'doesn't always log results,' and 'system incompatibility requires double data entry.'"
Study Design
Only postintervention (no control group)
Study Participants
Regional project managers, members of the regional project team, and end users were interviewed and/or asked to complete a survey questionnaire.