No magic bullets: a mixed methods case study to evaluate the implementation of an e-health system designed to support evidence-based practice in primary and community care settings.

  • Colin Cohen

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


The literature on e-health systems is frequently characterised by reports of success accompanied by the promise of a bright future, but the future never seems to arrive. The story of health informatics in England over the last decade has been dominated by the NHS National Programme for IT. One element of that programme is the Map of Medicine, a software tool designed to deliver evidence-based clinical knowledge from authoritative sources. Although the system had been made available to users across the NHS, very little was known about whether health professionals actually used it. The aim of this project was to undertake a mixed methods case study to evaluate the implementation of the Map of Medicine in primary and community care settings. The main findings from the quantitative phase of the case study were that around half of the GPs and around a quarter of Community health staff used the system. The findings from the qualitative phase indicated some marked differences between the two groups in terms of why they did, or did not, use the system. Normalisation Process Theory was used as a lens to understand how practices became embedded, or failed to become embedded, into their social context. It is concluded that emphasising the technical aspects of system implementation at the expense of the social aspects probably accounted for much of the variation in use, but there are no simple project management checklists that can guarantee successful implementation. Finally, the implications are considered. Policy makers need to take account of the social factors when implementing e-health systems, to recognise that it can take a long time for systems to become normalised and that there are risks from withdrawing project support before changes in working practices have become embedded. The health informatics profession needs to become more evidence-based, and the evaluation of e-health should play the same role as clinical audit does for the medical profession.
Date of Award3 Jul 2014
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorAlan Buckingham (Supervisor)

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