Adoption and perception of electronic clinical communications in Scotland

Claudia Pagliari, Peter Donnan, Jill Morrison, Ian Ricketts, Peter Gregor, Frank Sullivan


Objectives To determine the uptake of multiple eHealth facilities enabled by the NHS Scotland Electronic Clinical Communications Implementation Programme (ECCI) and to ascertain primary and secondary care users' perceptions.
Design Prospective monthly measurement of 37 indicators of roll-out and adoption. Retrospective questionnaire survey of users.
Setting Scottish health board regions. Quantitative implementation indicators were gathered in primary and secondary care across all 16 regions. Questionnaire data were obtained from recorded users in five representative regions (112 general practices, 92 secondary care units).
Outcome measures Change in uptake levels of ECCI facilities over a 15-month period. Users' perceptions of benefits, facilitators and barriers.
Results All health boards participated in the monthly data set collection. The response rate to the survey was 62% in primary care and 37% in secondary care. Across Scotland as a whole, the process of implementation was gradual. While there were marked gains inthe availability of ECCI facilities over the observation period, rates of adoption lagged behind and varied across alternative facilities. Electronic results were widely used, with most laboratories offering them and around half of general practices receiving them. More modest rates of adoption were observed for e-discharge letters, e-referrals, e-clinic letters and clinical email. E-booking was used very little. Among engaged users responding to the survey, electronic access to test results was the most frequently utilised facility and electronic outpatient booking the least. Perceived benefits of ECCI facilities included convenience, ease of use, time-saving and provision of an audit trail. Perceived barriers included the need to duplicate data entry where new systems were not universally implemented, technological difficulties, time, training and resources.
Conclusions Significant progress was observed in the implementation of ECCI facilities across Scotland. Users reported that these improved communication and were beneficial, but system reliability, incompatibility and duplication of data hindered more widespread uptake. Data were collected at a transitional phase of the programme. Whilst, among users of ECCI facilities, perceptions of the programme and its potential benefits were generally positive, its full impact will not become evident until the new electronic tools are implemented nationally and have been more fully integrated into normal work routines.


electronic clinical communications; eHealth; information management and technology

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