Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

The Norwegian National Summary Care Record: a qualitative analysis of doctors’ use of and trust in shared patient information

Authors: Kari Dyb, Line Lundvoll Warth

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

This paper explores Norwegian doctors’ use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals’ use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors’ direct SCR experiences.

Methods

We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach.

Results

The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool’s six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data.

Conclusion

Therefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust in – and therefore more often utilise – automatically updated information. In addition, the doctors’ lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.
Appendix
Available only for authorised users
Literature
1.
Greenhalgh T, Stramer K, Bratan T, Byrne E, Mohammad Y, Russell J. Introduction of shared electronic records: multi-site case study using diffusion of innovation theory. BMJ. 2008. doi.​org/​10.​1136/​bmj.​c3111
2.
3.
4.
Chantler T, Lwembe S, Saliba V, Raj T, Mays N, Ramsay M, Mounier-Jack S. “It’s a complex mesh”- how large-scale health system reorganisation affected the delivery of the immunisation programme in England: a qualitative study. BMC Health Serv Res. 2016. doi.​org/​10.​1186/​s12913-016-1711-0
5.
6.
May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A et al. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Sci. 2009. doi.​org/​10.​1186/​1748-5908-4-29
7.
Pope C, Halford S, Turnbull J, Prichard J, Calestani M, May C. Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory. BMC Health Serv Res. 2013. doi.​org/​10.​1186/​1472-6963-13-111
8.
9.
Westbrook JI, Braithwaite J. Will information and communication technology disrupt the health system and deliver on its promise? Med J Aust. 2010;193(7):399–400.PubMed
10.
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, Hinder S, Fahy N, Procter R, Shaw S. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res. 2017; https://​doi.​org/​10.​2196/​jmir.​8775.
11.
12.
Ellingsen G, Monteiro E. Big is beautiful: electronic patient records in large Norwegian hospitals 1980s-2001. Methods Inf Med. 2003;42(4):366–70.CrossRefPubMed
13.
Hanseth O, Jacucci E, Grisot M, Aanestad M. Reflexive standardization: side effects and complexity in standard making. MIS Q. 2006:563–81.
14.
Gagnon M-P, Shaw N, Sicotte C, Mathieu L, Leduc Y, Duplantie J, Maclean J, Légaré F. Users’ perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol. Implement Sci. 2009. doi.​org/​10.​1186/​1748-5908-4-20
15.
Castillo VH, Martínez-García AI, Pulido J. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak. 2010. doi.​org/​10.​1186/​1472-6947-10-60
16.
17.
18.
Greenhalgh T, Morris L, Wyatt JC, Thomas G, Gunning K. Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland. Int J Med Inform. 2013;82(5):e125–e38.CrossRefPubMed
19.
Greenhalgh T, Stramer K, Bratan T, Byrne E, Russell J, Potts HH. The Devil’s in the detail: final report of the independent evaluation of the summary care record and HealthSpace programmes. London: University College London; 2010.
20.
Greenhalgh T, Stramer K, Bratan T, Byrne E, Russell J, Potts HW. Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study. BMJ. 2010. doi.​org/​10.​1136/​bmj.​c3111
21.
22.
Craig J, Morris L, Cameron J, Setters J, Varley D, Lay A, Thompson I. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J. 2015;60(3):126–31.CrossRefPubMed
23.
Heimly V, Berntsen K. Consent-based access to core EHR information. Methods Inf Med. 2009;48(2):144–8.PubMed
24.
Warth LL, Dyb K. A qualitative study of the implementation and use of a national information system. Proceedings in the International Conference on eHealth. 2017;2017:3–10.
25.
Remen VM, Grimsmo A. Closing information gaps with shared electronic patient summaries–how much will it matter? Int J Med Inform. 2011;80(11):775–81.CrossRefPubMed
26.
27.
Hauge HN. Den digitale helsetjenesten. (The Digital Health Service). 1st ed. Oslo: Gyldendal akademiske;2017.
28.
Tjora A. Kvalitative forskningsmetoder i praksis. (qualitative research methods ). 1st ed. Oslo: Gyldendal Akademisk; 2010.
29.
Denzin NK. The reflexive interview and a performative social science. Qual Res. 2001;1(1):23–46.CrossRef
30.
Denzin NK. Interpretive interactionism. vol. 16. Thousand Oaks: Sage; 2001.
31.
Olsen H. Kvalitative kvaler: kvalitative metoder og danske kvalitative interviewundersøgelsers kvalitet. (Qualitative reflections). 1st ed. Copenhagen: Akademisk; 2002.
32.
Järvinen M. Interview i en interaktionistisk begrepsramme (qualitative methods in an interactionist perspective). 1st ed. Hans Reitzel: Copenhagen; 2005.
33.
Jones K. The turn to a narrative knowing of persons. In: Rapport F, editor. New qualitative methodologies in health and social care research. New York: Routledge; 2004. p. 35–54.CrossRef
34.
Wengraf T. Qualitative research interviewing: Biographic narrative and semi-structured methods. Thousand Oaks: Sage; 2001.
35.
Fossåskaret E, Fuglestad OL, Aase TH. Metodisk feltarbeid: produksjon og tolkning av kvalitative data. (Metodology and Fieldwork). 1st ed. Oslo: Universitetsforlaget; 1997.
36.
Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research: transaction publishers. 2009.
37.
Scott T, Rundall TG, Vogt TM, Hsu J, Aarts J. Implementing an electronic medical record system: success, failures, lessons. Oxford: Radcliffe Publishing; 2007.
38.
May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.CrossRef
39.
Sharman Z. Remembering the basics: administrative technology and nursing care in a hospital emergency department. Int J Med Inform. 2007;76:S222–S8.CrossRefPubMed
40.
Greenhalgh T, Potts HW, Wong G, Bark P, Swinglehurst D. Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. The Milbank Quarterly. 2009;87(4):729–88.CrossRefPubMedPubMedCentral
41.
MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, Rogers A, Bardsley M, Newman SP. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract. 2014;64(624):e401–e7.CrossRefPubMedPubMedCentral
42.
43.
Garavand A, Mohseni M, Asadi H, Etemadi M, Moradi-Joo M, Moosavi A. Factors influencing the adoption of health information technologies: a systematic review. Electronic physician. 2016;8(8):2713–8.CrossRefPubMedPubMedCentral
44.
Hodge JG Jr, Gostin LO, Jacobson PD. Legal issues concerning electronic health information: privacy, quality, and liability. JAMA. 1999;282(15):1466–71.CrossRefPubMed
45.
Ancker JS, Edwards AM, Miller MC, Kaushal R. Consumer perceptions of electronic health information exchange. Am J Prev Med. 2012;43(1):76–80.CrossRefPubMed
46.
Dyb K, Halford S. Placing globalizing technologies: telemedicine and the making of difference. Sociology. 2009;43(2):232–49.CrossRef
Metadata
Title
The Norwegian National Summary Care Record: a qualitative analysis of doctors’ use of and trust in shared patient information
Authors
Kari Dyb
Line Lundvoll Warth
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3069-y

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Corruption practices in drug prescribing in Vietnam – an analysis based on qualitative interviews

Research article

Understanding the effectiveness and mechanisms of a social prescribing service: a mixed method analysis

Study protocol

Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: the YAM DAABO study protocol

Study protocol

Surgeons and preventative health: protocol for a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons

Research article

The cost of a pediatric neurocritical care program for traumatic brain injury: a retrospective cohort study

Research article

Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting