International Journal of Medical Informatics
Volume 78, Issue 9 , Pages 588-604 , September 2009

Expectations and experiences of eHealth in primary care: A qualitative practice-based investigation

  • Donal Flynn

      Affiliations

    • Manchester Business School, University of Manchester, Booth Street West, Manchester M15 6PB, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 (0)161 306 3333.
    • ,
  • Peggy Gregory

      Affiliations

    • School of Computing, Engineering and Physical Sciences, University of Central Lancashire, UK
    • ,
  • Hani Makki

      Affiliations

    • Health Dialog, UK
    • ,
  • Mark Gabbay

      Affiliations

    • Division of Primary Care, University of Liverpool, UK

Received 31 October 2008 ,Revised 19 March 2009 ,Accepted 30 March 2009.

References 

  1. Pagliari C. Design and evaluation in eHealth: challenges and implications for an interdisciplinary field. J. Med. Internet Res. 2007;9(2):e15
  2. Gustafson DH, Wyatt JC. Evaluation of ehealth systems and services. Br. Med. J. 2004;328:1150
  3. Jackson CL, Bolen S, Brancati FL, Batts-Turner ML, Gary TL. A systematic review of interactive computer-assisted technology in diabetes care. J. Gen. Intern. Med. 2006;21:105–110
  4. Prokhorov AV, Yost T, Mullin-Jones M, DeMoor C, Ford KH, Marani S, et al. Look at your health: outcomes associated with a computer-assisted smoking cessation counseling intervention for community college students. Addict. Behav. 2008;33(6):757–771
  5. Garcia-Lizana F, Sarria-Santamera A. New technologies for chronic disease management and control: a systematic review. J. Telemed. Telecare. 2007;13(2):62–68
  6. Wyatt JC, Sullivan F. eHealth and the future: promise or peril?. Br. Med. J. 2005;331:1391–1393
  7. Green J, McDowall Z, Potts HWW. Does Choose & Book fail to deliver the expected choice to patients? A survey of patients’ experience of outpatient appointment booking. BMC Med. Inf. Decis. Making. 2008;8:36
  8. Hassol A, Walker JM, Kidder D, et al. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J. Am. Med. Inf. Assoc. 2004;11(November–December (6)):505–513
  9. Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient Internet portal? The PatientSite experience. J. Am. Med. Inf. Assoc. 2006;13(1):91–95
  10. Winkelman WJ, Leonard KJ, Rossos PG. Patient-perceived usefulness of online electronic medical records: employing grounded theory in the development of information and communication technologies for use by patients living with chronic illness. J. Am. Med. Inf. Assoc. 2005;12(3):306–314
  11. Ross SE, Todd J, Moore LA, Beaty BL, Wittevrongel L, Lin C-T. Expectations of patients and physicians regarding patient-accessible medical records. J. Med. Internet Res. 2005;7(2):e13
  12. Andreassen HK, Bujnowska-Fedak MM, Chronaki CE, Dumitru RC, Pudule I, Santana S, et al. European citizens’ use of e-health services: a study of seven countries. BMC Public Health. 2007;7:53
  13. Neville RG, Greene AC, Lewis S. Patient and health care professional views and experiences of computer agent-supported health care. Inf. Prim. Care. 2006;14(1):11–15
  14. Greenhalgh T, Wood GW, Bratan T, Stramer K, Hinder S. Patients’ attitudes to the summary care record and HealthSpace: qualitative study. Br. Med. J. 2008;336:1290–1295
  15. Coulter A. Engaging Patients in their Healthcare—How is the UK doing Relative to other Countries?. Oxford: Picker Institute Europe; 2006;
  16. Richards H, King G, Reid M, Selvaraj S, McNicol I, Brebner E, et al. Remote working: survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom. Fam. Pract. 2005;22(February (1)):2–7
  17. Shaw BR, Han JY, Hawkins RP, Stewart J, McTavish F, Gustafson DH. Doctor–patient relationship as motivation and outcome: examining uses of an interactive cancer communication system. Int. J. Med. Inf. 2007;76(4):274–282
  18. Ferreira A, Correia A, Silva A, Corte A, Pinto A, Saavedra A, et al. Why facilitate patient access to medical records?. Stud. Health Technol. Inf. 2007;127:77–90
  19. Pagliari C, Detmer D, Singleton P. Potential of electronic personal health records. Br. Med. J. 2007;335:330–333
  20. Delpierre C, Cuzin L, Fillaux J, Alvarez M, Massip P, Lang T. A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?. Int. J. Qual. Health Care. 2004;16(5):407–416
  21. Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med. Care. 2006;44:964–971
  22. McMahon GT, Gomes HE, Hickson Hohne S, Hu TM-J, Levine BA, Conlin PR. Web-based care management in patients with poorly controlled diabetes. Diab. Care. 2005;28(7):1624–1629
  23. Blaikie N. Designing Social Research. Cambridge: Polity Press; 2000;
  24. Creswell JW. Research Design: Qualitative, Quantitative and Mixed Methods Approaches. 2nd ed.. Sage; 2003;
  25. Avison D, Pries-Heje J. Research in Information Systems: A Handbook For Research Supervisors and their Students. Butterworth-Heinemann; 2005;
  26. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine; 1967;
  27. Grinnell RM, Unrau YA. Social Work Research and Evaluation: Foundations of Evidence-Based Practice. US: Oxford University Press; 2008;
  28. Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. Br. Med. J. 2006;333:417
  29. Walker A, O’Brien M, Traynor J, Fox K, Goddard E, Foster K. Living in Britain. London: The Office of National Statistics; 2002;
  30. H. Jimison, P. Gorman, S. Woods, et al., Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. Evidence Report/Technology Assessment No. 175 (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024), AHRQ Publication No. 09-E004. Rockville, MD, Agency for Healthcare Research and Quality, November 2008.
  31. CfH, Connecting for Health: Choose and Book hits 10 millionth booking landmark, http://www.connectingforhealth.nhs.uk/newsroom/news-stories/cab10m/?searchterm=choosessed, accessed January 28 2009.
  32. BMA, Choose and Book – Learning Lessons from Local Experience, British Medical Association Working Party on NHS IT, January 2009, http://www.bma.org.uk/images/chooseandbook_tcm41-181729.pdf.
  33. PHR, Private communication, January 2009.
  34. Allan JL. The intention–behaviour gap—it's all under control (executive control). Eur. Health Psychol. 2008;10(September):62–64
  35. Amireault S, Godin G, Vohl MC, et al. Moderators of the intention–behaviour and perceived behavioural control–behaviour relationships for leisure-time physical activity. Int. J. Behav. Nutr. Phys. Act. 2008;5:7
  36. Verheijden MW, Jans MP, Hildebrandt VH. Web-based tailored lifestyle programs: exploration of the target group's interests and implications for practice. Health Promot. Pract. 2008;9:82–92
  37. Ajzen I. The theory of planned behavior. Org. Behav. Human Decis. Process. 1991;50:179–211
  38. Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol. Health. 2005;20(April (2)):143–160
  39. Roddy E, Antoniak M, Britton J, et al. Barriers and motivators to gaining access to smoking cessation services amongst deprived smokers—a qualitative study. BMC Health Serv. Res. 2006;6:147
  40. Asthana S, Gibson A. Deprivation, demography, and the distribution of general practice: challenging the conventional wisdom of inverse care. Br. J. Gen. Pract. 2008;58(October (555)):720–726
  41. Kressig RW, Echt KV. Exercise prescribing: computer application in older adults. Gerontologist. 2002;42(2):273–277
  42. Rubin G, Bate A, George A, Shackley P, Hall N. Preferences for access to the GP: a discrete choice experiment. Br. J. Gen. Pract. 2006;56(531):743–748
  43. Van’t Riet A, Berg M, Hiddema F, et al. Meeting patients’ needs with patient information systems: potential benefits of qualitative research methods. Int. J. Med. Inf. 2001;64(1):1–14
  44. Lober WB, Zierler B, Herbaugh A, et al. Barriers to the use of a personal health record by an elderly population. In: AMIA Annual Symposium Proceedings 2006, AMIA Symposium. 2006;p. 514–518
  45. EHTEL, eHealth – care in the home: a position paper, European Health Telematics Association (EHTEL), 25 September 2006, http://www.ehtel.org/.
  46. Griffiths F, Lindenmeyer A, Powell J, et al. Why are health care interventions delivered over the Internet? A systematic review of the published literature. J. Med. Internet Res. 2006;8(2):e10
  47. Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann. Intern. Med. 2006;144(10):742–752
  48. P.G. Shekelle, S.C. Morton, E.B. Keeler, Costs and benefits of health information technology, Evidence Report/Technology Assessment No. 132, April 2006, AHRQ Publication No. 06-E006. Rockville, MD, Agency for Healthcare Research and Quality, http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf.
  49. D. Blumenthal, C. DesRoches, K. Donelan, et al., Health information technology in the United States: the information base for progress, Robert Wood Johnson Foundation, 2006, http://hitadoption.org/downloads/annual_report_2006.pdf.
  50. Heeks R. Health information systems: failure, success and improvisation. Int. J. Med. Inf. 2006;75:125–137
  51. Pan GSC, Flynn DJ. Information systems project abandonment: a case of political influence by the stakeholders. Technol. Anal. Strategic Manag. 2003;15(December (4)):457–466
  52. Taylor SE. Tend and befriend: biobehavioral bases of affiliation under stress. Curr. Dir. Psychol. Sci. 2006;15(6):273–277
  53. C.B. Nemeroff, Human contact and affection are powerful stress reducers (Interview), http://health.discovery.com/centers/stress/interviews/nemeroff.html, accessed January 28 2009.
  54. Miller GE, Wrosch C. You’ve gotta know when to fold ‘em: goal disengagement and systemic inflammation in adolescence. Psychol. Sci. 2007;18:773–777
  55. Feil EG, Glasgow RE, Boles S, et al. Who participates in Internet-based self-management programs? A study among novice computer users in a primary care setting. Diab. Educ. 2000;26(5):806–811
  56. Schärer LO, Hartweg V, Valerius G, et al. Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients. Bipolar Disord. 2002;4(Suppl. 1):107–108
  57. Cotten SR, Gupta SS. Characteristics of online and offline health information seekers and factors that discriminate between them. Soc. Sci. Med. 2004;59(9):1795–1806
  58. Dutta-Bergman MJ. Health attitudes, health cognitions, and health behaviors among Internet health information seekers: population-based survey. J. Med. Internet Res. 2004;6(May (2)):e15
  59. Norman CD, Skinner HA. eHEALS: the eHealth literacy scale. J. Med. Internet Res. 2006;8(Nov (4)):e27
  60. Navarro FH, Wilkins ST. A new perspective on consumer health web use: “valuegraphic” profiles of health information seekers. Manag. Care Q. 2001;9(2):35–43
  61. Ad Hoc Committee on Health Literacy, Health literacy: report of the Council on Scientific Affairs, American Medical Association, JAMA 281 (6) (1999) 552–557.
  62. Longo DR. Understanding health information, communication, and information seeking of patients and consumers: a comprehensive and integrated model. Health Expect. 2005;8:189–194
  63. Houston TK, Allison JJ. Users of Internet health information: differences by health status. J. Med. Internet Res. 2002;4(2):e7
  64. Alpay LL, Toussaint PJ, Ezendam NPM, Rovekamp TAJM, Graafmans WC, Westendorp RGJ. Easing Internet access of health information for elderly users. Health Inf. J. 2004;10(3):185–194
  65. Andersson NB, Hanson E, Magnusson L. Views of family carers and older people of information technology. Br. J. Nurs. 2002;11(12):827–831
  66. Eysenbach G, Jadad AR. Evidence-based patient choice and consumer health informatics in the Internet age. J. Med. Internet Res. 2001;3(2):e19
  67. HealthSpace, Profile – HealthSpace, eHealth Insider Reports, http://www.ehealtheurope.net/ehi_reports/HealthSpace.pdf, accessed January 22, 2009.
  68. EMIS, “EMIS offers GP practices system for patients to access health records online”, http://www.bjhcim.co.uk/news/2008/n807013.htm, accessed 28 January 2009.
  69. Kaelber DC, Jha AK, Johnston D. A research agenda for personal health records (PHRs). J. Am. Med. Inf. Assoc. 2008;15:729–736
  70. Chan TYK. Incidence of herb-induced aconitine poisoning in Hong Kong: impact of publicity measures to promote awareness among the herbalists and the public. Drug Saf. 2002;25(11):823–828
  71. Goldney RD, Fisher LJ, Dal Grande E, et al. Have education and publicity about depression made a difference? Comparison of prevalence, service use and excess costs in South Australia: 1998 and 2004. Aust. N. Z. J. Psychiatry. 2007;41(January (1)):38–53
  72. E-Health Insider, Top tips: promoting new electronic services, http://www.e-health-insider.com/Features/item.cfm?docId=84, accessed February 1 2009.
  73. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289:1969–1975
  74. Falkman G, Gustafsson M, Jontell M, et al. SOMWeb: a semantic web-based system for supporting collaboration of distributed medical communities of practice. J. Med. Internet Res. 2008;10(August (3)):e25
  75. Beath CM. Supporting the information technology champion. MIS Q. 1991;15(3):355–372Sept
  76. European Commission – Information Society and Media, eHealth in action: good practices in European countries, European Commission, January 2009, http://ec.europa.eu/information_society/activities/health/docs/studies/2009good_eHealth-report.pdf.
  77. Robertson R, Dixon A, Le Grand J. Patient choice in general practice: the implications of patient satisfaction surveys. J. Health Serv. Res. Policy. 2008;13(2):67–72
  78. Tarrant C, Stokes T, Baker R. Factors associated with patients’ trust in their general practitioner: a cross-sectional survey. Br. J. Gen. Pract. 2003;53(October (495)):798–800
  79. Neville RG, Greene C, Lewis S. Patient and health care professional views and experiences of computer agent-supported health care. Inf. Prim. Care. 2006;14(1):11–15
  80. Wears RL, Berg M. Computer technology and clinical work: still waiting for Godot. JAMA. 2005;293(10):1261–1263
  81. Hersh W. Health care information technology: progress and barriers. JAMA. 2004;292(18):2273–2274
  82. Poon EG, Blumenthal D, Jaggi T, et al. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff. (Millwood). 2004;23(4):184–190
  83. Wald HS, Dube CE, Anthony DC. Untangling the web – the impact of Internet use on health care and the physician–patient relationship. Patient Educ. Counsel. 2007;68:218–224
  84. Flocke SA, Gordon LE, Pomiecko GL. Evaluation of a community health promotion resource for primary care practices. Am. J. Prev. Med. 2006;30(3):243–251
  85. Curran JA, Abidi SSR. Evaluation of an online discussion forum for emergency practitioners. Health Inf. J. 2007;13:255–266
  86. Leonard KJ, Sittig DF. Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT. J. Med. Internet Res. 2007;9(2):e9
  87. Robey D, Boudreau M-C, Rose GM. Information technology and organizational learning: a review and assessment of research.. Account. Manag. Inf. Technol. 2000;10:125–155
  88. Staples DS, Wonga I, Seddon PB. Having expectations of information systems benefits that match received benefits: does it really matter?. Inf. Manag. 2002;40:115–131
  89. Delone WH, McLean ER. The DeLone and McLean model of information systems success: a ten-year update. J. Manag. Info. Sys. 2003;19(Spring (4)):9–30
  90. Hirschheim R, Lacity M. The myths and realities of information technology insourcing. Commun. ACM. 2000;43(February (2)):99–107
  91. Flynn DJ, Hussain ZI. Seeking legitimation for an information system: a preliminary activity model. In: Proceedings of 12th European Conference on Information Systems. Turku, Finland, June 14–16. 2004;
  92. Eason K. Local sociotechnical system development in the NHS National Programme for Information Technology. J. Inf. Technol. 2007;22:257–264
  93. Orlikowski WJ, Hofman JD. An improvisational model for change management: the case of groupware technologies. Sloan Manag. Rev. 1997;38(2):11–21
  94. Johnson KB. Barriers that impede the adoption of pediatric information technology. Arch. Pediatr. Adolesc. Med. 2001;155(12):1374–1379
  95. Reardon JL, Davidson E. An organizational learning perspective on the assimilation of electronic medical records among small physician practices. Eur. J. Inf. Syst. 2007;16:681–694
  96. Pan GSC, Flynn DJ. Why information systems project post-mortems fail: an attribution perspective. In: Proceedings of International Conference on Information Systems (ICIS 2003). Seattle, Washington, December 14–17. 2003;p. 366–377
  97. Devitt N, Murphy J. A survey of the information management and technology training needs of doctors in an acute NHS trust in the United Kingdom. Health Inf. Libr. J. 2004;21(3):164–172
  98. Majeed A. Ten ways to improve information technology in the NHS. Br. Med. J. 2003;326(January (7382)):202–206
  99. Kernick DP, Reinhold DM, Mitchell A. How should patients consult? A study of the differences in viewpoint between doctors and patients. Fam. Pract. 1999;16(December (6)):562–565
  100. Jacobson L, Richardson G, Parry-Langdon N, et al. How do teenagers and primary healthcare providers view each other? An overview of key themes. Br. J. Gen. Pract. 2001;51(October (471)):811–816
  101. Neville RG, Marsden W, McCowan C, et al. A survey of GP attitudes to and experiences of email consultations. Inf. Prim. Care December. 2004;12(4):201–206
  102. Car J, Sheikh A. Email consultations in health care. 1. Scope and effectiveness. BMJ. 2004;329:435–438
  103. Car J, Sheikh A. Email consultations in health care. 2. Acceptability and safe application. BMJ. 2004;329:439–442
  104. Rosen P, Kwoh CK. Patient-physician e-mail: an opportunity to transform pediatric health care delivery. Pediatrics. 2007;120:701–706
  105. Roter DL, Larson S, Sands DZ, et al. Can e-mail messages between patients and physicians be patient-centered?. Health Commun. 2008;23(January–February (1)):80–86
  106. Health Services Journal, Patients to get final say on who sees NHS records, Health Services Journal, 18 September 2008, http://www.hsj.co.uk/printPage.html?pageid=1851677, accessed February 2 2009.
  107. Salmon P, Hall GM. Patient empowerment and control: a psychological discourse in the service of medicine. Soc. Sci. Med. 2003;57(November (10)):1969–1980
  108. Lee YY, Lin JL. Linking patients’ trust in physicians to health outcomes. Br. J. Hosp. Med. (Lond.). 2008;69(January (1)):42–46
  109. Weng HC. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient–physician relationship, and satisfaction. Health Care Manag. Rev. 2008;33(October–December (4)):280–288
  110. Rodriguez HP, von Glahn T, Chang H, Rogers WH, Safran DG. Measuring patients’ experiences with individual specialist physicians and their practices. Am. J. Med. Qual. 2009;24(January–February (1)):35–44
  111. Gornall J. Electronic patient records: reasons to be cheerful. Br. Med. J. 2008;336(February):390
  112. Keen J. The NHS programme for information technology. Br. Med. J. 2006;333:3–4

PII: S1386-5056(09)00055-0

doi: 10.1016/j.ijmedinf.2009.03.008

International Journal of Medical Informatics
Volume 78, Issue 9 , Pages 588-604 , September 2009

Article Tools