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BMC Medical Informatics and Decision Making

, 14:93

Healthcare Information Systems


BackgroundEffective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway eForm allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.

MethodsWe conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement PCIP and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.

ResultsIn January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.

ConclusionThe adoption of the eForm into routine preoperative work practices can be attributed to: i a policy context – including performance targets – promoting the rationalisation of surgical pre-assessment pathways, ii financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, iii a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, iv the use of a pragmatic and domain-agnostic technology solution and finally: v a consensual and contextualised implementation.

KeywordsMesh Medical informatics applications Information systems Integrated advanced information management systems AbbreviationsACHAcute care hospital

BADSBritish Association of Day Surgery

CHICommunity health index

ECSEmergency care summary

eFormElectronic form also: electronic Integrated Care Pathway in the context of this article

ENTEar, nose and throat

EPRElectronic patient record

GPGeneral practitioner

ICPIntegrated care pathway

ICTInformation and

CTcommunication technology

MDTpreoperative Multi-disciplinary team

NHS GGCNHS Greater Glasgow and Clyde health-board NHSScotland: National Health Service for Scotland

NPfITNational Programme for Information Technology

NPTNormalisation process theory

OTOperating theatre

PACSurgical Pre-assessment clinic

PCIPPlanned care improvement programme

POAPre-operative assessment

SCIScottish care information group

SCI GatewayThe national eReferral system developed by the NHSScotland SCI group

SCI StoreElectronic data repositories managed by each of the regional health-boards.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6947-14-93 contains supplementary material, which is available to authorized users.

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Autor: Matt-Mouley Bouamrane - Frances S Mair


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