title: Bottom-up and middle-out approaches to electronic patient information systems: a focus on healthcare pathways.
abstract: BACKGROUND
  A study is reported that examines the use of electronic health record (EHR) systems in two UK local health communities.
  
  
  OBJECTIVE
  These systems were developed locally and the aim of the study was to explore how well they were supporting the coordination  of care along healthcare pathways that cross the organisational boundaries between the agencies delivering health care.
  
  
  RESULTS
  The paper presents the findings for two healthcare pathways; the Stroke Pathway and a pathway for the care of the frail elderly in their own homes. All  the pathways examined involved multiple agencies and many locally tailored EHR systems are in use to aid the coordination of care. However, the ability to share electronic patient information along the pathways was patchy. The development of systems that did enable effective sharing of information  was characterised by sociotechnical system development, i.e. associating the technical development with process changes and organisational changes, with local development teams that drew on all the relevant agencies in the local health community and on evolutionary development, as experience  grew of the benefits that EHR systems could deliver.
  
  
  CONCLUSIONS
  The study concludes that whilst there may be a role for a national IT strategy, for example, to set standards for systems procurement that facilitate data interchange, most systems development work needs to be done  at a 'middle-out' level in the local health community, where joint planning between healthcare agencies can occur, and at the local healthcare pathway level where systems can be matched to specific needs for information sharing.
authors: Loughborough Design School, Loughborough University, UK. k.d.eason@lboro.ac.uk
authors: Ken
authors: K
authors: Eason
authors: Mike
authors: M
authors: Dent
authors: Patrick
authors: P
authors: Waterson
authors: Dylan
authors: D
authors: Tutt
authors: Andrew
authors: A
authors: Thornett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D013222:State Medicine / Q000458:organization & administration; D020521:Stroke / Q000628:therapy; D006113:United Kingdom