Thursday, June 17, 2010

SCR & Healthspace evaluation published

Today a major evaluation report of England's Summary Care Record (SCR) and HealthSpace programmes has been published at

I haven't yet digested the full 234 pages, but I have scanned the executive summary (p9-21( and it appears to be an extensive multi-level mixed-method study which has examined the initiatives from a variety of perspectives and disparate data sources. It follows a previous report which was instrumental in changing the consent model used in the SCR.

A couple of intriguing paragraphs which have leapt out at me & I will investigate further:

* In a pilot study supported by an independent IT supplier in which district nurses were lent portable digital assistant (PDA) devices to access the SCRs of patients they visited on their rounds, initial technical and operational challenges were overcome for the duration of the pilot. Overall, the nurses found PDAs useful and many accessed SCRs regularly, though they would have liked more clinical information on the records. The PDAs were recalled by the supplier and subsequent negotiations centred on the cost of supplying the devices and who would meet these costs.

* A number of ‘wicked’ (pervasive, seemingly insoluble) problems became recurring agenda items in national and/or local meetings. Wicked problems had a number of common characteristics:
a. They spanned the different ‘worlds’ of different stakeholder groups, which brought different assumptions and values;
b. They involved a tension between different philosophical models of reality (‘hard’, rationalistic, factual versus ‘soft’, contextualised, interpretive);
c. They tended to include a claim on contested resources (i.e. not everyone agreed that money or time should be spent on them);
d. They were vulnerable to multiple external influences, some of which were not under the control of those charged with ‘fixing’ them;
e. They had complex interdependencies with other problems and issues in the programme; and
f. They produced unanticipated ramifications elsewhere in the system.

* The most striking overall characteristic of the SCR and HealthSpace programmes was their scale and complexity. They can be thought of as emerging from a heterogeneous socio-technical network with multiple interlocking sub-networks:

* The SCR and HealthSpace programmes spanned a number of different ‘worlds’ – political, clinical, technical, commercial, academic – with different institutional logics, as well as the personal world of the patient.

* The huge scale of the programmes inevitably brought increased complexity as well as a tension between ‘national coordination’ and ‘local ownership’. The tension between standardisation (which helps stabilise the socio-technical network) and contingency (which reflects and responds to local needs and priorities) can never be resolved;

* The NHS and professional bodies should consider the implications of this study for training and support of front-line staff. Our empirical data highlight the lack of predictability or universal solutions at the level of the fine-grained detail of the patient encounter.

Other comments about this report are beginning to emerge eg:
* SCR and HealthSpace too complex, say academics - Smart
* Millions have online medical records 'without knowing it' - Telegraph
* Long-awaited report reveals 'insoluble' flaws in Summary Care Record rollout - PULSE
* Health e-records 'struggling to fulfil potential' -BBC
* Will Summary Care Records do more harm than good? - Computer Weekly
* SCR evaluation finds few benefits - EHealthInsider

I'm sure there will be lots more comment to come.

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