title: Boundaries and e-health implementation in health and social care.
abstract: BACKGROUND
  The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost.
  
  
  METHODS
  To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations.
  
  
  RESULTS
  Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs' understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals.
  
  
  CONCLUSIONS
  To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment.
authors.affiliation: General Practice and Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: King
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Donnell
authors.forename: David
authors.initials: D
authors.lastname: Boddy
authors.forename: Fiona
authors.initials: F
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Heaney
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
mesh_terms: D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000295:instrumentation / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation / Q000191:economics; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000191:economics / Q000592:standards; D006694:Holistic Health / Q000191:economics; D006801:Humans; D007373:Interinstitutional Relations; D009111:Local Government; D008297:Male; D009313:National Health Programs; D019982:Organizational Case Studies; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D012189:Retrospective Studies; D019035:Rural Health Services; D012606:Scotland; D018511:Systems Integration; D000078329:Workforce