Do integrated record systems lead to integrated services? An observational study of a multi-professional system in a diabetes service.

Purpose: There are few opportunities to study the use of integrated electronic health record (EHR) systems, where single patient records are used by a number of health care staff. The purpose of the study was to understand how an integrated electronic health record system was used by health care staff in the treatment and management of diabetes patients. The investigation was focused on the interface between the primary and secondary care services which patients access for their diabetes care.

Methods: Observations of the use of an integrated electronic health record during patients' consultations with health care staff were conducted over a three month period. Twelve patients were followed through their consultations with a range of health care staff at a secondary care Diabetes Centre and in primary care settings. A thematic analysis of the observation data was undertaken.

Results: The integrated electronic health record system had been implemented across the primary and secondary care interface and was used by many, but not all, clinicians involved in the care of patients with diabetes. In some areas of care it enabled health care staff to access more accurate and detailed information to inform their clinical decision-making. Issues including negotiating rules for accessing patient records and duplication of recording in paper record systems had not been resolved consistently across services.

Conclusions: The findings offer suggestive evidence that a shared electronic health record can support more integrated care. Unresolved issues in implementing the system across all services and settings highlight the governance problems that can arise when systems are developed locally but are then extended across organisational and professional boundaries.