Evaluation of IT modernisation in the NHS - NETSCC

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Report to SDO for NCRS ProjectExecutive Summary3. MethodsThe study sample consisted of four NHS Acute Trusts. We used a combination ofqualitative and quantitative methods to address our objectives, making comparisonsboth within and between organisations. We used review methods to summariseexisting evidence for objective 4.A qualitative researcher interviewed a range of stakeholders involved in implementingand using IT applications, and addressed objectives 1 and 2. Two levels ofinterviews were conducted in three stages. Level 1 interviews (objective 1), tookplace between July and October 2004 (stage A; n=24); and between February andApril 2006 (stage A; n=25). Level 2 interviews (objective 2) took place betweenJanuary and October 2005 (n=44). Baseline information was also collected for eachstudy site data.Level 1 interviews investigated (a) the influence of contextual factors (historical orcurrent, facilitators or barriers) on the implementation of IT applications, and (b) theimpact of recent Connecting of Health policy changes on implementation processes.Level 2 interviews investigated (a) experiences of NHS staff of specific ITapplications (electronic test ordering and browsing, or computerised physician orderentry, CPOE; electronic booking; picture archiving and communication systems,PACS), and (b) the impact of these applications on working practices. Interviewswere semi-structured on a one-to-one basis and took about one hour. Interviewswere taped and transcribed.We applied a modified grounded theory analytic strategy to present an analysis ofprocesses over time. This strategy combined drawing on the literature onorganisational change, and more user-centred sociological theories of innovationadoption and implementation, with themes emerging from the data.The quantitative research used a quasi-experimental ‘controlled before-and-after’design to quantify the effects of implementing CPOE and PACS. Indicators werecompared between trusts that did and did not implement these IT applications duringthe period 2000 to 2005, taking into account data for a baseline period prior toimplementing changes. Indicators were also compared within Trusts betweenspecialties that did and did not implement the applications during the same period.
Report to SDO for NCRS ProjectExecutive SummaryTo estimate the effects of CPOE, we considered three tests: full blood count, ureaand electrolytes, and urine culture. For PACS, we considered three radiologicalmodalities: plain film X-ray, computed tomography (CT), and ultrasound.Indicators were derived from a large set defined a priori, based partly on the NHSEfficiency Map and were classified as primary or secondary depending on theplausibility of a direct causal pathway between implementation and the outcome.We analysed inpatient and outpatient data from the Commissioning Data Set (CDS)for 2000 to 2005, linked with data about target pathology and radiology tests carriedout during the same period. Secondary outcomes were derived directly from the CDSdata. Individual patient data were analysed for specialties common to all four trusts.Effects were estimated by multiple regression modelling, calculating robust standarderrors to take into account clustering of records within trusts and specialties.4. FindingsImplementation of the NPfIT did not progress as expected during the study period.Findings from Level 1 of our qualitative study were able to track the impact of thisdelay on the trusts.CPOE and PACS applications were also implemented infrequently during the project.Three of four Trusts implemented aspects of PACS system, but only one Trustimplemented a ‘full’ PACS. Two Trusts implemented CPOE but, in one trust, thesystem was so poor it was hardly used so, in effect, had not been implemented.None of the applications studied were officially compliant with the NPfIT.Our quantitative and qualitative evaluations of PACs and CPOE were constrained tosome extent because implementation of IT applications was not as widespread asexpected when the research was commissioned. Nevertheless, our findings provideuseful lessons as the roll-out of IT modernisation in the NHS gathers pace.4.1 Qualitative findings: Level 1 – Implementation of NPfIT at local levelStage A interviews, with senior managers and clinicians, highlighted four key issues:(a) Trusts varied in their circumstances, affecting their ability to implement the NPfIT.(b) The process of implementing the NPfIT was suboptimal, leading to low moraleamong NHS staff responsible for implementation.
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Evaluation of IT modernisation in the NHS - NETSCC

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