Jasmine Harvey

A large provider of community health services (an NHS Trust in England) deployed Apple iPads to its front-line community-based healthcare clinicians (predominantly nurses) to enable them to increase responsiveness to patients’ and their families’ needs. We conducted a participatory formative evaluation of this iPad initiative among different users and the informatics teams implementing it, to establish how such initiatives can sustain adoption and achieve their stated benefits. We used a participatory approach involving a partnership between study investigators and key decision-makers of the initiative to engage stakeholders in the study. Methods included focus groups and group discussion, meetings with key personnel and analysis of documents related to the initiative. Using a participatory technique, members of the organisation identified practical challenges to inform the on-going process of implementation and adoption in the Trust. Healthcare professionals identified many benefits associated with having iPads to support care delivery, including streamlined workflows and accessible information at the point-of-care in the community. However, challenges that interfered with implementation were also reported by both the team implementing the initiative (IT team) and early users. Challenges reported by IT team are: adopter clinicians’ scepticism and suspicion; clinician non-compliance with training and operational guidance procedures; and managing adopter expectations. Challenges reported by users are: setting-up and maintaining the devices on a long-term basis; blurring of personal and professional boundaries; and disconnection from the IT team. Results show that these challenges could be overcome if there were more informal ‘socialised’ interactions between adopters and between adopters and the IT team. We suggest that similar initiatives require increased ongoing dialogue between different levels of stakeholder groups, in the form of socialised engagements, to avoid common misunderstandings and to promote the processes involved in co-constructing the initiative on a generally-agreed and sustainable basis.

The use of digital healthcare to complement, aid, or replace traditional healthcare has been debated as having the potential to empower patients to take responsibility in managing their conditions, streamline workloads of healthcare professionals, and be cost-effective for the National Health Service in England. Despite this, national programmes to implement digital health solutions have been problematic, and this has been debated from various perspectives. This paper aims to add to the debate from a perspective that considers whether daily discourses of society play a role in conditioning the public against scalable digital health solutions.

In a research context, self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging. We conducted an interpretive qualitative synthesis of relevant articles identified through systematic searches of bibliographic databases in July 2014. We searched PubMed (Medline/NLM), Web of Science, LISTA (EBSCO), CINAHL, Embase and PsycINFO. Coding and analysis was inductive, using the framework method to code and to categorise themes. We took a sensemaking approach to the interpretation of findings. Fifty-eight articles were selected for synthesis. Results showed that during adoption, factors identified as facilitators by some were experienced as barriers by others, and facilitators could change to barriers for the same adopter, depending on how adopters rationalise the solutions within their context when making decisions about (retaining) adoption. Sometimes, when adopters saw and experienced benefits of a solution, they continued using the solution but changed their minds when they could no longer see the benefits. Thus, adopters placed a positive value on the solution if they could constructively rationalise it (which increased adoption) and attached a negative rationale (decreasing adoption) if the solution did not meet their expectations. Key factors that influenced the way adopters rationalised the solutions consisted of costs and the added value of the solution to them and moral, social, motivational and cultural factors. Considering ‘barriers’ and ‘facilitators’ for implementation may be too simplistic. Implementers could instead iteratively re-evaluate how potential facilitators and barriers are being experienced by adopters throughout the implementation process, to help adopters to retain constructive evaluations of the solution. Implementers need to pay attention to factors including (a) cost: how much resource will the intervention cost the patient or professional; (b) moral: to what extent will people adhere because they want to be ‘good’ patients and professionals; (c) social: the expectations of patients and professionals regarding the interactive support they will receive; (d) motivational: motivations to engage with the intervention and (e) cultural: how patients and professionals learn and integrate new skills into their daily routines, practices and cultures.

Objectives: To explore attitudes and perceptions of early adopters of the Electronic Prescription Service (release two) in England (EPS2). EPS2 is information technology that allows community pharmacies to download and dispense electronically written prescriptions from general practices. When the prescriber writes a prescription electronically, it is sent and stored on a national central database, commonly called the Spine. The community pharmacy that the patient nominates is then able to download the prescription and dispense to the patient. Method: In-depth interviews were conducted with professionals from eight early adopter community pharmacies in the midlands and north of England, and 56 hours of non-participant observations were recorded as field notes. Each interview transcript was coded using a line-by-line approach. Overall, 37 200 words were analysed from 10 transcripts using a ‘bottom up’ approach to identify key perceptions. Field notes from the observation were analysed thematically and were used to verify interview findings. Key findings: Findings follow a narrative which shows that (a) early adopter pharmacies had to cope with challenges such as missing EPS2 prescriptions, (b) despite this, they perceived EPS2 as helpful in streamlining pharmacy workflow and (c) were therefore keen to retain EPS2. Conclusions: Initial user perception of EPS2 provides a key message on the likelihood of the system being adopted beyond these eight pharmacies. Our findings provide key information for other pharmacies in the adoption process, and policymakers on the potential of EPS2 to achieve its goals and become sustainable in terms of its value to community pharmacies.

The Electronic Prescription Service release Two (EPS2) is a new national healthcare information and communication technology in England that aims to deliver effective prescription writing, dispensing and reimbursement service to benefit patients. The aim of the study was to explore initial user experiences of Community Pharmacists (CPs) using EPS2. We conducted nonparticipant observations and interviews in eight EPS2 early adopter community pharmacies classified as ‘first-of-type’ in midlands and northern regions in England. We interviewed eight pharmacists and two dispensers in addition to 56 hours recorded nonparticipant observations as field notes. Line-by-line coding and thematic analysis was conducted on the interview transcripts and field notes. CPs faced two types of challenge. The first was to do with missing electronic prescriptions. This was sometimes very disrupting to work practice, but pharmacists considered it a temporary issue resolvable with minor modifications to the system and user familiarity. The second was to do with long term design-specific issues. Pharmacists could only overcome these by using the system in ways not intended by the developers. Some felt that these issues would not exist had ‘real’ users been involved in the initial development. The issues were: 1) printing out electronic prescriptions (tokens) to dispense from for safe dispensing practices and to free up monitors for other uses, 2) logging all dispensing activities with one user’s Smartcard for convenience and use all human resources in the pharmacy, and, 3) problematic interface causing issues with endorsing prescriptions and claiming reimbursements. We question if these unintended uses and barriers would have occurred had a more rigorous user-centric principles been applied at the earlier stages of design and implementation of EPS. We conclude that, since modification can occur at the evaluation stage, there is still scope for some of these barriers to be corrected to address the needs, and enhance the experiences, of CPs using the service, and make recommendations on how current challenges could be resolved.

A number of national and international agencies have pointed to identity management (IM) as one of the main private and public challenges of the future. The issue is subject to intense public controversy and contestation, especially with respect to access to, usage and ownership of personal data. Most work about IM assumes users to be rational actors making instrumental choices on the basis of perceived usefulness and efficiency; cultural narratives hardly ever come up in current research about acceptance of new identity management technologies (IMTs). Screen representations do not prescribe certain meanings around IM, but create and delineate horizons of imagination; repositories of meanings from which people can draw to make sense of innovations and their consequences. In this paper, we focus on a sample of films, television and web series to examine how IMTs are premediated. Our analysis suggests that a whole range of future IM (knowledge- and token-based, as well as biometric/implant) technologies is imagined here, with biometric and implant technologies most likely to be taken to (dystopian) extremes. Stories of identity theft and confusion, surveillance and control, comfort and corruption construct them as potentially problematic and always under threat, as well as calling up existential concerns about what it means to be human. We conclude that these dark horizons are anchored in myth and persistent fears about who we are, and thus that new means of IM face a difficult task in gaining users' trust.

The introduction of a new method of transmitting prescriptions from general practices to community pharmacies in England (Electronic Prescription Service Release 2 (EPS2)) has generated debate on how it will change work practice. As EPS2 will be a key technical element in dispensing, we reviewed the literature to find that there were no studies on how social and technical elements come together to form work practice in community pharmacies. This means the debate has little point of reference. Our aim therefore was to study the ways social and technical elements of a community pharmacy are used to achieve dispensing through the development of a conceptual model on pharmacy work practice, and to consider how a core technical element such the EPS2 could change work practice.

Cultural Acceptance of ICTs: Perceptions in Practice: 10.4018/978-1-61520-799-2.ch006: The emergence of new information and communication technologies (ICTs) has generated much debate both in and out of academia in relation to theories ranging

As part of the National Programme for IT (NPfIT) in England, the Electronic Prescription Service (EPS) is being implemented in two releases. The first release placed barcodes on prescriptions and is widely implemented. Release two (EPS2), the electronic transmission of prescriptions between GP, pharmacy and the reimbursement body, has just started implementation. On the NPfIT agenda, community pharmacies have been predicted to benefit from changes in work practice following the full EPS implementation. The study focused on how the advanced EPS (EPS2) might alter dispensing work practice in community pharmacies on issues such as workflow and workload; and the bearing of these issues on improvement in quality of service and safety. This paper demonstrates how findings of the pre-implementation study were used to provide formative feedback to the implementers. A mixed ethnographical method that combined non- participant observations, shadowing and interviews, before and after implementation, was used to qualitatively study eight community pharmacies across three early adopter Primary Care Trusts (PCTs) in England. Key implementation issues were fed-back to the PCTs as part of the EPS2 rolling-out process. Staff access to dispensing terminals needs to be improved if electronic dispensing is to be encouraged. Also, as a safety issue, pharmacists are planning to print off electronic prescriptions (tokens) and dispense from them. Although safer, this could increase workload. The EPS2 could positively alter work practice by improving certain demanding aspects of dispensing whilst reducing human errors. For example, the high demand of customers handing in prescriptions and waiting for them to be dispensed could be reduced through automation. Also, the extreme variation in workload during various times of the day could be evened out to improve workflow and provide a better service; however, in order for this to be fully realized, technical issues such as number of staff per dispensing station and dispensing from tokens would need to be addressed.