Clinician perceptions of scanned health records

1. University of Portsmouth Clinician perceptions of scanned health records Research Student:Philip Scott MScDirector of Studies: Dr. J. Briggs Supervisors: Professor A. Narayanan, Dr. C. Fitch Centre for Healthcare Modelling and Informatics,School of Computing Introduction Healthcare funding agencies are investing heavily in information systems. Multi-million pound electronic health record (EHR) programmes are underway, including NHS Connecting for Health in England, Informing Healthcare in NHS Wales, Health InfoWay in Canada and KP Health Connect in Kaiser Permanente. However, little if any substantive theory is available from health informatics research to date. Over 1200 health informatics papers were published between 1982 and 2005 (Ammenwerth & de Keizer, 2006), yet the evidence about EHR effects is relatively weak (Clamp & Keen, 2006). Moreover, we know that clinical usage and interpretation of paper documentation and records is problematic and that computerization does not in itself solve the problems (Powsner, Costa, & Homer, 2000; Wright, Jansen, & Wyatt, 1998). Grounded Theory Grounded theory (GT) is a predominantly inductive approach which systematically generates an integrated set of hypotheses to explain behaviour patterns in relation to a central issue (Glaser & Strauss, 1967; Charmaz, 2006). It is based on the fact that actors in a given setting are somehow dealing with their situation; we unpack the data to propose a theoretical framework of what is happening. We conceptualise the data to generate abstract categories. We ask, "What is the main problem? How is it being resolved?“ We write memos to track and stimulate analytical thinking and document the generation of concepts and hypothesised relations. We accumulate conceptual interrelations, leading to the emergence of a core variable that is central and explains most of the variation in behaviour patterns. Based on the core category, we theoretically sample further data from selected groups to enrich our knowledge until we reach saturation, when no new categories, properties or relations are emerging in relation to the core. We treat the literature and our personal knowledge as data to be analysed in the study. The emergent GT is not the “voice” of the participants but our generated abstract model. The Helper Research Approach The broad research question is “What are clinicians’ experiences of EHRs?” This may include effects on time and working practice; emotional reactions; satisfaction; content interpretation; confidentiality issues; effects on intra- and inter-disciplinary communications. The initial investigation is a qualitative grounded theory study using a series of semi-structured focus groups and individual interviews with a mix of clinicians in the UK and the USA using scanned health records. The objective is to generate theory rather than to test a specific hypothesis. References Ammenwerth, E., & de Keizer, N. (2006). A web-based inventory of evaluation studies in medical informatics. Retrieved 7 July 2006 from http://evaldb.umit.at/index.htm Charmaz, K. (2006). Constructing grounded theory: a practical guide through qualitative analysis. London: Sage. Clamp, S., & Keen, J. (2006). Electronic health records: is the evidence base any use?In J. Bryant (Ed.), Proceedings of Healthcare Computing 2006 (pp.143-150). Harrogate: BCS Health Informatics Forum. Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: strategies for qualitative research. New York: Aldine de Gruyter. Powsner, S. M., Costa, J., & Homer, R. J. (2000). Clinicians are from Mars and pathologists are from Venus. Arch Pathol Lab Med, 124(7), 1040-1046. Wright, P., Jansen, C., & Wyatt, J. C. (1998). How to limit clinical errors in interpretation of data. Lancet, 352(9139), 1539-1543. Conclusions Although elements of GT have been used in health informatics, we suggest this will be the first study in this field to apply the full methodology to generate a theory not just a thematic analysis. We suggest this is the first qualitative study involving clinician usage of scanned health records. We shall propose how the emergent theory can be subjected to further analysis with other methodologies, whether quantitative or qualitative. Contact: philip.scott@port.ac.uk 07766 254169