Continuous innovation: developing and using a clinical database with new technology for patient-centred care--the case of the Swedish quality register for arthritis.

Objective: We describe and explain the development of a clinical quality database and its use for different clinical, management and patient empowerment purposes.

Design: A longitudinal case study covering 1993-2009.

Setting: Rheumatology departments in Swedish hospitals.

Participants: Those involved in developing the clinical database and its applications and a limited number of users.

Intervention(s): Different methods for inputting and storing clinical and patient data and for analysing and presenting the data to providers and patients.

Main Outcome Measure(s): Participants' perceptions of the value of different applications and of influences, which helped and hindered the development of the system.

Results: Different innovations were introduced at different times continually to increase the ultility of the clinical data and the clinic- and patient coverage of the clinical data system. Limited interview data show postive patient and provider perceptions of the latest application to collect and present data as time trend visual display in the clinical consultation.

Conclusions: A longitudinal perspective revealed how a clinical quality register was developed and how new technologies not imagined in the early 1990s continue to increase the ultility and value of the clinical database. This historical perspective provided limited evidence of impact, but does provide lessons for current strategies for innovation for quality in health care and of the need to consider innovolution processes, rather than discrete innovations, given the rapid pace of change in new technologies. More evidence is needed of the impact of such registers, and of enhancements, on providers and patients and on costs.