title: Establishing data-intensive healthcare: the case of Hospital Electronic Prescribing and Medicines Administration systems in Scotland.
abstract: Creating learning health systems, characterised by the use and repeated reuse of demographic, process and clinical data to improve the safety, quality and efficiency of care, is a key aim in realising the potential benefits and efficiency savings associated with the implementation of health information technology.
  
  
  
  We sought to investigate stakeholder perspectives on and experiences of the implementation of hospital electronic prescribing and medicines administration (HEPMA) systems in Scotland and use these to inform political decisions on approaches to promoting the use and reuse of digitised prescribing and medication administration data in order to improve care processes and outcomes.Methods We identified and recruited key national stakeholders involved in implementing and/or using HEPMA data from generic and specialty systems. These included representatives from healthcare settings (i.e. doctors, pharmacists and nurses), managers of existing national databases, policy makers, healthcare analytics companies, system suppliers and patient representatives. We conducted multi-disciplinary focus group discussions, audio-recorded these, transcribed data verbatim and thematically analysed the transcripts with the help of NVivo10. In analysing the data, we drew on theoretical and previous empirical work on information infrastructures.
  
  
  
  We identified the following key themes: 1) micro-factors - usability of systems and motivating users to input data; 2) meso-factors - developing technical and organisational infrastructures to facilitate the aggregation of data; and 3) macro-factors - facilitating interoperability and data reuse at larger scales to ensure that data are effectively generated and used.
  
  
  
  This work is relevant not only to countries in the early stages of data strategy development but also to countries aiming to aggregate data at national levels. An overall shared vision of a learning health system at individual, organisational and national levels can help to catalyse such data-intensive transformational efforts.
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh. kathrin.beyer@ed.ac.uk.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Cresswell
authors.affiliation: . pam.smith@ed.ac.uk.
authors.forename: Pam
authors.initials: P
authors.lastname: Smith
authors.affiliation: . cpswainson@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Swainson
authors.affiliation: . angela.timoney@nhs.net.
authors.forename: Angela
authors.initials: A
authors.lastname: Timoney
authors.affiliation: . aziz.sheikh@ed.ac.uk.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D055695:Electronic Prescribing; D006761:Hospitals; D006801:Humans; D008490:Medical Informatics; D008510:Medication Systems, Hospital; D010595:Pharmacists; D011787:Quality of Health Care; D012606:Scotland
keywords: big data; data strategy; health information technology