Interpretive Flexibility Along the Innovation Decision Process of the UK NHS Care Records Service (NCRS): Insights from a Local Implementation Case Study

Interpretive Flexibility Along the Innovation Decision Process of the UK NHS Care Records Service (NCRS): Insights from a Local Implementation Case Study

Anastasia Papazafeiropoulou (Brunel University, UK) and Reshma Gandecha (Brunel University, UK)
DOI: 10.4018/978-1-60566-142-1.ch010
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Interpretive flexibility is a term used to describe the diverse perspectives on what a technology is and can or can not do during the process of technological development. In this chapter, we look at how interpretive flexibility manifests through the diverse perceptions of stakeholders involved in the diffusion and adoption of the NHS Care Records Service (NCRS). Our analysis shows that while the policy makers acting upon the application of details related to the implementation of the system, the potential users are far behind the innovation decision process, namely at the knowledge or persuasion stages. We use data from a local heath authority from a county close to London. The research explores, compares, and evaluates contrasting views on the systems implementation at the local as well as national level. We believe that our analysis is useful for NCRS implementation strategies, in particular, and technology diffusion in large organisations, in general.
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With medical errors becoming a cruel reality in the provision of healthcare worldwide, the role of information technology in preventing those errors becomes predominant. It is recognised that more people die every year due to medical errors than from vehicle accidents, breast cancer, or AIDS (Kohn, et al. 2000). The American Hospital Association CDER (2004) relates the vast majority of medication errors to lack of appropriate information and processes such as:

  • Incomplete patient information

  • Unavailable drug information

  • Miscommunication of drug orders due to poor handwriting, similarly named drugs, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations

  • Lack of appropriate labelling

  • Environmental factors, such as lighting, heat, noise, and interruptions that can distract health professionals from their medical tasks.

One way to reduce medical errors is to make efficient, accurate, reliable medical decisions, based on reliable and up-to-date information or patient records. Integrated patient records can reduce medical errors by using information technology (Booth, 2002). Medical errors can be reduced with the provision of order entry systems with computerized prescriptions and using bar-coding for medications, blood, devices, and patients. In order to avoid the medical errors, medical centres are investing in computerized patient records, bringing patients and clinicians within the ambit of an integrated health care system that provides real-time patient records. Nelson (1998) cites the American Medical Association (AMA) as stating that 30% of all patient visits are completed without access to the patient’s chart. Access anytime anywhere to patient information, by the concerned and authorized persons, is the key concept of computerized patient records. Medical errors are reduced when all hospitals implement proven medication safety practices using computerized medication lists and health care providers can readily see patient medications and avoid duplications of tests.

In this article, we are looking at the diffusion and adoption of the NHS (National Health Service) Care Records Service (NCRS) in the United Kingdom, which has the potential to support healthcare professionals by offering an integrated electronic patience record system that would potentially reduce medical errors. It is worth mentioning that the medical care in the United Kingdom is a social service and not fee-paid as in other countries such as the United States. This has great implications for the modernisation of the health care system, which is of high political importance and one of the main priorities in the United Kingdom’s government agenda. This service is one of the four key deliverables set out in the NHS IT procurement strategy “Delivering 21st Century IT Support for the NHS,” published in June 2002. NCRS is a portfolio of services covering the generation, movement, and access to health records, which includes electronic prescribing in hospitals and workflow capacities to manage patients’ care pathways through the NHS. Its benefits include convenience, integration of care, improving outcomes using evidence, supporting analysis, and improving efficiency (NHSIA, 1998). With estimates that 25% of nurse and doctor time is taken up collecting data, and the potential increase in speed and efficiency of communication, the benefits appear very straightforward with the promise of “seamless care” (NHSIA, 1998).

The proposed system will work by assisting all healthcare professionals and other prospective users. Whenever they log on to the system, they will be presented with a personal home page permitting them to combine a number of screens. Then, they will be in a position to look for a patient by a 10-digit NHS number or a known detail such as name, date of birth, age, sex, phone number, or their general practitioner’s (GP) name. Also, patients will be in a position to view their own records and ultimately become involved in planning their treatment by the use of the “My health space” feature on the NHS Direct web site. The “data spine” is planned to go live in three phases:

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Editorial Advisory Board
Table of Contents
Chapter 1
Claus Hohmann
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Emotional Digitalization as Technology of the Post-Modern: A Reflexive Examination from the View of The Industry
Chapter 2
Elias A. Hadzilias, Andrea Carugati
This chapter aims at defining a framework for the design of e-government services on cultural heritage. Starting from an analysis of three cases on... Sample PDF
Bridging User Requirements and Cultural Objects: A Process-Oriented Framework for Cultural E-Services
Chapter 3
Samantha Bax, Tanya McGill
The technology acceptance model (TAM) is a popular model for the prediction of information systems acceptance behaviors, defining a causal linkage... Sample PDF
From Beliefs to Success: Utilizing an Expanded TAM to Predict Web Page Development Success
Chapter 4
George E. Heilman, Jorge Brusa
This study assesses the psychometric properties of a Spanish translation of Doll and Torkzadeh’s End- User Computing Satisfaction (EUCS) survey... Sample PDF
Assessing a Spanish Translation of the End-User Computing Satisfaction Instrument
Chapter 5
Ishraga Khattab, Steve Love
Over the last several years, the ubiquitous use of mobile phones by people from different cultures has grown enormously. For example, mobile phones... Sample PDF
Understanding the Impact of Culture on Mobile Phone Usage on Public Places: A Comparison between the UK and Sudan
Chapter 6
Netta Iivari
Users should participate in information technology (IT) artifact development, but it has proven to be challenging. This applies also in the open... Sample PDF
Discourses on User Participation: Findings from Open Source Software Development Context
Chapter 7
Anita Greenhill, Gordon Fletcher
In this article we build upon existing research and commentary from a variety of disciplinary sources, including information systems, organisational... Sample PDF
Exploring "Events" as an Information Systems Research Methodology
Chapter 8
Hannakaisa Isomäki
This chapter describes a study clarifying information systems (IS) designers’ conceptions of human users of IS by drawing on in-depth interviews... Sample PDF
Different Levels of Information Systems Designers' Forms of Thought and Potential for Human-Centered Design
Chapter 9
Barbara Jones, Angelo Failla, Bob Miller
Constant renewal of the self-image and self-knowledge of the organisation becomes part of the day-to-day knowledge-in-use of front-line... Sample PDF
Tacit Knowledge in Rapidly Evolving Organisational Environments
Chapter 10
Anastasia Papazafeiropoulou, Reshma Gandecha
Interpretive flexibility is a term used to describe the diverse perspectives on what a technology is and can or can not do during the process of... Sample PDF
Interpretive Flexibility Along the Innovation Decision Process of the UK NHS Care Records Service (NCRS): Insights from a Local Implementation Case Study
Chapter 11
Sylvie Albert, Rolland LeBrasseur
This article reviews the literature on networks and, more specifically, on the development of community telecommunication networks. It strives to... Sample PDF
Collaboration Challenges in Community Telecommunication Networks
Chapter 12
Mary R. Lind
In this article, wireless technology use is addressed with a focus on the factors that underlie wireless interaction. A de-construction of the... Sample PDF
A De-Construction of Wireless Device Usage
Chapter 13
François-Xavier de Vaujany
The following chapter suggests a critical realistic framework, which aims at modeling sociotechnical change linked to end-users’ IT appropriation... Sample PDF
Modeling Sociotechnical Change in IS with a Quantitative Longitudinal Approach: The PPR Method
Chapter 14
Janet C. Dunlop
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The U.S. Video Game Industry: Analyzing Representation of Gender and Race
Chapter 15
Luciano Floridi
The article argues that Information Ethics (IE) can provide a successful approach for coping with the challenges posed by our increasingly... Sample PDF
Global Information Ethics: The Importance of Being Environmentally Earnest
Chapter 16
Philip Brey
In this chapter, I examine whether information ethics is culture relative. If it is, different approaches to information ethics are required in... Sample PDF
Is Information Ethics Culture-Relative?
Chapter 17
John Weckert
This chapter examines the concept of offence, both its giving and taking, and argues that such an examination can shed some light on global ethical... Sample PDF
Giving and Taking Offence in a Global Context
Chapter 18
Reima Suomi, Ari Serkkola, Markku Mikkonen
In this chapter we focus on the application of a mobile time reservation system for dental care. The specific application allocates cancelled... Sample PDF
GSM-Based SMS Time Reservation System for Dental Care
Chapter 19
Debra Howcroft, Robert McDonald
Both academics and practitioners have invested considerably in the information systems evaluation arena, yet rewards remain elusive. The aim of this... Sample PDF
An Ethnographic Study of IS Investment Appraisal
Chapter 20
Kevin Gallagher, Robert M. Mason
This chapter frames the requirements definition phase of systems design as a problem of knowledge transfer and learning between two communities of... Sample PDF
Reframing Information System Design as Learning Across Communities of Practice
Chapter 21
Tanya Bondarouk, Maarten van Riemsdijk
In this chapter, we conceptualize the implementation process associated with SAP_HR as an experiential learning one (Kolb, 1984), and analyze... Sample PDF
Successes and Failures of SAP Implementation: A Learning Perspective
Chapter 22
Pietro Murano, Patrik O’Brian Holt
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Anthropomorphic Feedback in User Interfaces: The Effect of Personality Traits, Context and Grice's Maxims on Effectiveness and Preferences
Chapter 23
Richard Diamond
This study explores decision premises that were used to manage and stabilise a complex technochange programme in a financial institution. Decision... Sample PDF
Several Simple Shared Stable Decision Premises for Technochange
Chapter 24
Alison Adam, Paul Spedding
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Trusting Computers Through Trusting Humans: Software Verification in a Safety-Critical Information System
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