Implementing integrated care infrastructure: A longitudinal study on the interplay of policies, interorganizational arrangements and interoperability in NHS England.

Background: New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms.

Method: This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure.

Integrating patient-centred and tumour-centred cancer care: the EU-MyPath implementation project offers an innovative digital solution with care pathways.

Cancer is one of the leading causes of mortality, with new cases expected to rise. Medical advances increase cure rates and prolong patient lives, but survivorship involves high symptom burden, loss of function and emotional distress. Improving patient-centred care (PCC) and quality of life throughout the care process is essential.

Essential strategic principles for planning and developing digitally enabled interventions in health and care settings.

Health and care information technologies can improve service delivery, but unfortunately many fail to realise their potential. This is because tools fail to effectively integrate with user and organisational practices. We here draw on two decades and an extensive body of practical and theoretical experience of conducting formative evaluations in health service settings to extract seven essential principles for planning and developing digital tools.

Governance intricacies in implementing regional shared care records: A qualitative study in the national health service, England.

Objectives: This study explores the governance intricacies in establishing a large-scale information infrastructure for integrated care within the National Health Service of England. By focusing on the initial 5 years of a regional interoperability program, we examine the challenges and dynamics of creating a unified system across organizational boundaries.

Methods: A longitudinal multi-methods approach was utilized, collecting data through interviews with health and social care personnel involved in project governance, meeting observations, and document analysis.

Evaluating Artificial Intelligence in Clinical Settings-Let Us Not Reinvent the Wheel.

Given the requirement to minimize the risks and maximize the benefits of technology applications in health care provision, there is an urgent need to incorporate theory-informed health IT (HIT) evaluation frameworks into existing and emerging guidelines for the evaluation of artificial intelligence (AI). Such frameworks can help developers, implementers, and strategic decision makers to build on experience and the existing empirical evidence base. We provide a pragmatic conceptual overview of selected concrete examples of how existing theory-informed HIT evaluation frameworks may be used to inform the safe development and implementation of AI in health care settings.

Complex Hospital-Based Electronic Prescribing-Based Intervention to Support Antimicrobial Stewardship: Qualitative Study.

Background: Antimicrobial resistance (AMR) represents a growing concern for public health.

Objective: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals.

Methods: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital.

Concerted adoption as an emerging strategy for digital transformation of healthcare-lessons from Australia, Canada, and England.

Objectives: With an increasing focus on the digitalization of health and care settings, there is significant scope to learn from international approaches to promote concerted adoption of electronic health records.

Materials And Methods: We review three large-scale initiatives from Australia, Canada, and England, and extract common lessons for future health and social care transformation strategy.

Results: We discuss how, despite differences in contexts, concerted adoption enables sharing of experience and learning to streamline the digital transformation of health and care.

Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework.

Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy.

Early Experiences of Integrating an Artificial Intelligence-Based Diagnostic Decision Support System into Radiology Settings: A Qualitative Study.

Artificial Intelligence (AI) based clinical decision support systems to aid diagnosis are increasingly being developed and implemented but with limited understanding of how such systems integrate with existing clinical work and organizational practices. We explored the early experiences of stakeholders using an AI-based e-learning imaging software tool Veye Lung Nodules (VLN) aiding the detection, classification, and measurement of pulmonary nodules in computed tomography scans of the chest. We performed semi-structured interviews and observations across early adopter deployment sites with clinicians, strategic decision-makers, suppliers, patients with long-term chest conditions, and academics with expertise in the use of diagnostic AI in radiology settings.

Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands.

Background: Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels.

Early experiences of integrating an artificial intelligence-based diagnostic decision support system into radiology settings: a qualitative study.

Objectives: Artificial intelligence (AI)-based clinical decision support systems to aid diagnosis are increasingly being developed and implemented but with limited understanding of how such systems integrate with existing clinical work and organizational practices. We explored the early experiences of stakeholders using an AI-based imaging software tool Veye Lung Nodules (VLN) aiding the detection, classification, and measurement of pulmonary nodules in computed tomography scans of the chest.

Materials And Methods: We performed semistructured interviews and observations across early adopter deployment sites with clinicians, strategic decision-makers, suppliers, patients with long-term chest conditions, and academics with expertise in the use of diagnostic AI in radiology settings.

Evaluation of Digitalisation in Healthcare and the Quantification of the "Unmeasurable".

Evaluating healthcare digitalisation, where technology implementation and adoption transforms existing socio-organisational processes, presents various challenges for outcome assessments. Populations are diverse, interventions are complex and evolving over time, meaningful comparisons are difficult as outcomes vary between settings, and outcomes take a long time to materialise and stabilise. Digitalisation may also have unanticipated impacts.

ePrescribing-Based Antimicrobial Stewardship Practices in an English National Health Service Hospital: Qualitative Interview Study Among Medical Prescribers and Pharmacists.

Background: Antimicrobial resistance, the ability of microorganisms to survive antimicrobial drugs, is a public health emergency. Although electronic prescribing (ePrescribing)-based interventions designed to reduce unnecessary antimicrobial usage exist, these often do not integrate effectively with existing workflows. As a result, ePrescribing-based interventions may have limited impact in addressing antimicrobial resistance.

A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial.

Background: Antimicrobial resistance is a leading global public health threat, with inappropriate use of antimicrobials in healthcare contributing to its development. Given this urgent need, we developed a complex ePrescribing-based Anti-Microbial Stewardship intervention (ePAMS+).

Methods: ePAMS+ includes educational and organisational behavioural elements, plus guideline-based clinical decision support to aid optimal antimicrobial use in hospital inpatients.

Socio-Organizational Dimensions: The Key to Advancing the Shared Care Record Agenda in Health and Social Care.

Integrating health and social care delivery with the help of digital technologies is a grand challenge. We argue that previous attempts have largely failed to achieve their objectives because implementers and decision makers disregard the complex socio-organizational dimensions of change associated with initiatives. These include structural and organizational complexity inhibiting the development of shared care pathways; professional jurisdictions, interests, and expertise; and existing data and governance structures.

What is brain fog?

Background: The term 'brain fog' is increasingly used colloquially to describe difficulties in the cognitive realm. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? This study examined first-person descriptions in order to better understand the phenomenology of brain fog.

Methods: Posts containing 'brain fog' were scraped from the social media platform Reddit, using python, over a week in October 2021.

Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study.

Background: The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind.

Objective: We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed.

Benefits realization management in the context of a national digital transformation initiative in English provider organizations.

Background: The Global Digital Exemplar (GDE) Programme is a national initiative to promote digitally enabled transformation in English provider organizations. The Programme applied benefits realization management techniques to promote and demonstrate transformative outcomes. This work was part of an independent national evaluation of the GDE Programme.

Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme.

Background: There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence.

Aim: To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme.

Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England.

Background: The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service.

Objective: This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge.

Methods: We conducted a formative qualitative evaluation of the GDE program.

Promoting inter-organisational knowledge sharing: A qualitative evaluation of England's Global Digital Exemplar and Fast Follower Programme.

Background: The Global Digital Exemplar (GDE) Programme was designed to promote the digitisation of hospital services in England. Selected provider organisations that were reasonably digitally-mature were funded with the expectation that they would achieve internationally recognised levels of excellence and act as exemplars ('GDE sites') and share their learning with somewhat less digitally-mature Fast Follower (FF) sites.

Aims: This paper explores how partnerships between GDE and FF sites have promoted knowledge sharing and learning between organisations.