title: Practice-centred evaluation and the privileging of care in health information technology evaluation.
abstract: Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context 'practice-centred' evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes.
  
  
  BACKGROUND
  Electronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts - can complement and in some instances offer advantages over, outcome-centric evaluation models.
  
  
  METHODS
  We carried out a regional programme of innovation in renal services where a participative approach was taken to the introduction of new technologies, including: a regional EPR system and a system to support video clinics. An 'action learning' approach was taken to procurement, pre-implementation planning, implementation, ongoing development and evaluation. Participants included clinicians, technology specialists, patients and external academic researchers. Whilst undergoing these activities we asked: how can a practice-centred approach be embedded into evaluation of health information technologies?
  
  
  CONCLUSIONS
  Organising EPR and telemedicine evaluation around predetermined outcome measures alone can be impractical given the complex and contingent nature of such projects. It also limits the extent to which unforeseen outcomes and new capabilities are recognised. Such evaluations often fail to improve understanding of 'when' and 'under what conditions' technology-enabled service improvements are realised, and crucially, how such innovation improves care.
  
  
  CONCLUSIONS
  Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context 'practice-centred' evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes.
authors.affiliation: School of Applied Social Science, Faculty of Health, University of Brighton, Mayfield House, Falmer BN1 9PH, UK. m.l.darking@brighton.ac.uk.
authors.forename: Mary
authors.initials: M
authors.lastname: Darking
authors.forename: Rachel
authors.initials: R
authors.lastname: Anson
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Bravo
authors.forename: Julie
authors.initials: J
authors.lastname: Davis
authors.forename: Steve
authors.initials: S
authors.lastname: Flowers
authors.forename: Emma
authors.initials: E
authors.lastname: Gillingham
authors.forename: Lawrence
authors.initials: L
authors.lastname: Goldberg
authors.forename: Paul
authors.initials: P
authors.lastname: Helliwell
authors.forename: Flis
authors.initials: F
authors.lastname: Henwood
authors.forename: Claire
authors.initials: C
authors.lastname: Hudson
authors.forename: Simon
authors.initials: S
authors.lastname: Latimer
authors.forename: Paul
authors.initials: P
authors.lastname: Lowes
authors.forename: Ian
authors.initials: I
authors.lastname: Stirling
mesh_terms: D057191:Capacity Building; D057286:Electronic Health Records; D004739:England; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008490:Medical Informatics; D017146:Models, Organizational; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D012040:Regional Health Planning; D012041:Regional Medical Programs / Q000458:organization & administration*; D013673:Technology Assessment, Biomedical; D017216:Telemedicine