Electronic Clinical Communications Implementation (ECCI) in Scotland: A mixed-methods programme evaluation

Aims: The Electronic Clinical Communications Implementation programme aims to facilitate implementation of electronic systems for primary-secondary care communication, focusing on laboratory results reporting, outpatient appointment booking, referral, discharge and clinic correspondence, and clinical e-mail. This independent programme evaluation explored the processes and outcomes of implementation, barriers and facilitators to system adoption, and benefits and drawbacks for professional users. Methods: The mixed methods approach incorporated document review, surveys, stakeholder interviews, consensus exercises, and monthly recording of quantitative process and outcome variables. Results: Qualitative and survey work highlighted wide variation in the technologies and implementation approaches adopted. A consensus process was used to instigate a national minimum dataset. To date, implementation of laboratory results reporting has demonstrated the greatest success and electronic outpatient booking the least. A mixed-format survey of users in clinical practice revealed a more detailed picture of behaviour and attitudes demonstrating that where systems are available and accepted they are utilized, while product usability, process complexity and user-engagement methods influence uptake. Conclusions: The evaluation has demonstrated the difficulties faced when attempting to implement a multifaceted technological and behavioural change intervention on a national scale, but has also revealed unexpected benefits, including general improvements in Information Management & Technology capability across the Scottish health service.