title: Electronic Clinical Communications Implementation (ECCI) in Scotland: a mixed-methods programme evaluation.
abstract: OBJECTIVE
  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.
authors.affiliation: Senior Lecturer (R&D), Department of General Practice, University of Dundee, Dundee, UK.h.c.pagliari@dundee.ac.uk
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Mhairi
authors.initials: M
authors.lastname: Gilmour
authors.forename: Frank
authors.initials: F
authors.lastname: Sullivan
mesh_terms: D017598:Efficiency, Organizational; D006302:Health Services Research; D008490:Medical Informatics / Q000458:organization & administration*; D009936:Organizational Innovation; D016730:Program Development; D015397:Program Evaluation; D012606:Scotland