Practice-centered evaluation and the privileging of care in health information technology evaluation

Darking, Mary, Anson, Rachel, Bravo, Fedinand, Davis, Julie, Flowers, Steve, Gillingham, Emma, Goldberg, Lawrence, Helliwell, Paul, Henwood, Flis, Hudson, Claire, Latimer, Simon, Lowes, Paul and Stirling, Ian (2014) Practice-centered evaluation and the privileging of care in health information technology evaluation BMC Health Services Research, 14. pp. 1-8. ISSN 1472-6963

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Abstract

Background: Electronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts - can complement and in some instances offer advantages over, outcome-centric evaluation models. Methods: We carried out a regional programme of innovation in renal services where a participative approach was taken to the introduction of new technologies, including: a regional EPR system and a system to support video clinics. An ‘action learning' approach was taken to procurement, pre-implementation planning, implementation, ongoing development and evaluation. Participants included clinicians, technology specialists, patients and external academic researchers. Whilst undergoing these activities we asked: how can a practice-centred approach be embedded into evaluation of health information technologies? Discussion: Organising EPR and telemedicine evaluation around predetermined outcome measures alone can be impractical given the complex and contingent nature of such projects. It also limits the extent to which unforeseen outcomes and new capabilities are recognised. Such evaluations often fail to improve understanding of ‘when' and ‘under what conditions' technology-enabled service improvements are realised, and crucially, how such innovation improves care. Summary: Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context ‘practice-centred' evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes.

Item Type: Journal article
Additional Information: © 2014 Darking et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
Uncontrolled Keywords: Electronic patient records; Telemedicine; Practice; Participatory methods; Care; Evaluation; Capability building
DOI (a stable link to the resource): 10.1186/1472-6963-14-243
Depositing User: Converis
Date Deposited: 09 Jan 2015 03:01
Last Modified: 11 Feb 2015 10:20
URI: http://eprints.brighton.ac.uk/id/eprint/13189

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