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首页> 外文期刊>Journal of Enterprise Information Management >The policy-practice nexus of electronic health records adoption in the UK NHS: An institutional analysis
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The policy-practice nexus of electronic health records adoption in the UK NHS: An institutional analysis

机译：英国NHS中采用电子健康记录的政策与实践的联系：一项制度分析

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Purpose - This paper seeks to report the findings from a seven-year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large-scale national ICT programme at an estimated value of ￡12.4bn. Design/methodology/approach - Using a longitudinal research method, data are collected on the policy-practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation. Findings - The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health-care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process. Research limitations/implications - This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice. Practical implications - The paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large-scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound "business case" have not been achieved. Originality/value - This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.
机译：目的-本文旨在报告一项针对英国国家卫生局（National Health Service）进行的为期七年的研究结果，该研究涉及引入5000万公民的电子健康记录。它探讨了在引入估计为124亿英镑的大规模国家ICT计划时政策与实践之间的关系。设计/方法/方法-使用纵向研究方法，收集有关政策-实践联系的数据。本文运用制度理论，使用托尔伯特和扎克的概念模型研究制度化的组成过程。调查结果-调查结果表明，机构力量在医疗保健环境中起到了推动和阻碍推动技术发展的作用。过程分析表明，由于电子健康记录对临床医生，医疗保健管理人员和患者造成了破坏性的变化，因此文化上嵌入的规范，价值观和行为模式会阻碍实施过程。研究的局限性/含意-由于政策的复杂性和所涉及的实际问题，该研究的可推广性仅限于国家，地区和地方ICT的实施。尽管进行了纵向研究，但制度理论的使用只能提供制度化的价值观，规范和行为如何影响卫生IT政策和实践的味道。实际意义-本文证明了将医疗保健中的集中ICT政策转换为临床医生和其他利益相关者的实际解决方案的复杂性。它显示了在尚未实现重要的用户参与问题和良好的“商业案例”的情况下，基于技术采购的大规模ICT计划不太可能成功。原创性/价值-该研究通过解决制度环境与技术环境之间的二分法，为制度主义的理论文献做出了贡献。尽管技术通常是在孤立的制度过程中进行讨论的，但它可能会嵌入组织实践中，达到沉淀（制度化）的过程，或者无法抓住并逐渐消失。

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