Towards a better understanding of delivering e-health systems : a systematic review using the meta-narrative method and two case studies

National Institute for Health Research - NIHR
National Institute for Health Research (NIHR)
Publication date:
30 April 2011


The introduction of e-Health has profound consequences for how health services work, not only in terms of patient outcomes but through organisational and service delivery changes. We aim to characterise these to help determine what factors promote the successful implementation of e-Health, something of particular importance in the context of the National Health Service's Connecting for Health programme.

Our theoretical basis draws on several models in health informatics, but also on the wider literature on human-computer interaction, organisational change and systems evaluation. We will use a set of case studies on e-Health technologies currently in use as part of NHS services. Our three main cases are a decision support tool for risk communication of cardiovascular disease risk factors in primary care; an electronic health record for patients with diabetes across primary and secondary care; and a complex system incorporating decision support and an electronic health record to support supplementary prescribers of anti-coagulation therapy, involving service re-organisation and again crossing primary and secondary care. These cover different parts of the country, different NHS and commercial stakeholders and different patient experiences.

We propose a multi-disciplinary, multi-method methodology in five, overlapping stages. (1) A review of the literature using the meta-narrative approach recently developed in a Service & Delivery Organisation project. (2) A document-based process analysis of the systems. These first two phases will inform the details of our subsequent work using a grounded theory approach. (3) Our main data collection is ethnographic, observational work following patient or healthcare professional journeys through their interactions with the systems. (4) A set of "mini" case studies to focus on particular areas using an array of methodologies as appropriate, including an analysis of the ethicolegal sequelae of system reorganisation; an economic analysis of how costs can shift between primary and secondary care; a study of role transformations and how they affect professional relationships; an assessment of training needs etc. In phases 3 and 4, we will adopt an iterative and reactive method where the research will adapt to the findings so as best to be able to study the hidden and unexpected consequences of e-Health. (5) Interactive feedback with patients and other stakeholders.

We will seek stakeholder input throughout the course of the research and disseminate our findings both locally and generally as they emerge. We will use the case studies to identify generic factors that facilitate or hinder the uptake and acceptance of information and communication systems by both patients and healthcare professionals.