Title: Poster Presentation
1Clinician perceptions of scanned health
records Research Student Philip Scott
MSc Director 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 Cha
rmaz, 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_at_port.ac.uk 07766 254169