title: Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Global Health, Policy and Innovation Unit, Barts and London School of Medicine and Dentistry, Abernethy Building, 2 Newark St., London E1 2AT, United Kingdom. p.greenhalgh@qmul.ac.uk
authors: Trisha
authors: T
authors: Greenhalgh
authors: Libby
authors: L
authors: Morris
authors: Jeremy C
authors: JC
authors: Wyatt
authors: Gwyn
authors: G
authors: Thomas
authors: Katey
authors: K
authors: Gunning
mesh_terms: D003299:Cooperative Behavior; D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D004739:England; D006801:Humans; D009660:Northern Ireland; D012606:Scotland; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D014852:Wales