Electronic information in health and social care - promises and pitfalls

In the last decade, major developments have taken place in England in the delivery of electronic information systems in both health care and social care. In the National Health Service (NHS), for example, the National Programme for Information Technology (NPfIT) set out to create electronic patient records that could be shared by all the agencies providing health care. In social care, in the wake of inquiries into the deaths of children, new information systems were put in place to improve the care provided by children's social workers. This special edition contains five articles that report research into the impact of these systems. They explore the promises of the systems and the pitfalls encountered in their delivery. They also report on the drivers for these innovations and the design processes by which they were implemented. As a consequence, they provide insights into the links between design methods and the adoption or non-adoption of systems when they are implemented in complex organisational settings. In the first article, Keen examines the political and institutional setting within which electronic information systems in the NHS have been developed from the 1960s and concludes that the dominant approach has been a centralised data processing strategy, the last manifestation of which is the NPfIT. He concludes that this approach is becoming increasingly ill-matched to the networked way in which health services are being delivered, where the emphasis is not upon reporting upwards but on coordinating care between the agencies and disciplines delivering care. However, far from seeing a move to electronic information systems that support frontline coordination of care, Keen identifies a continuing institutional logic that reinforces the centralised data processing model. Among the forces retaining this logic is the move to Open Data which requires the collection of standardised data that can be aggregated for planners and policy makers, sustaining the need for centralised definitions of systems. Dent and Tutt also adopt an institutional perspective and take further the question of how electronic health systems support health-care pathways in the NHS. They identify health-care pathways as a dominant form of institutional logic serving the integration agenda, that is, the need for the many agencies providing health and social care to be better coordinated in their care of patients. As a result of studies in the Electronic Patient Information Crossing Organisational Boundaries (EPICOg) project, they show how, in two local health communities, health-care pathways are being developed …