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Abstract: Purpose: The purpose of the study was to understand the preparations for the introduction of electronic patient record systems (EPRs) within the outpatient services department of a large acute hospital based in the UK. In particular, one of the main aims of the study was to examine in detail the likely impact of EPRs on the working practices of healthcare workers, their expectations regarding the impact of EPRs within the department and other sociotechnical aspects of the management of patient information. Methods: Twenty-seven semi-structured interviews were undertaken with staff in a variety of roles that deal with the management of medical records. The interviews focused on the organisation of the medical records department and current problems (e.g., missing records). In addition, the interviews contained questions about the specific role of medical records supervisors in the administration of records, as well as pathways and expectations about EPRs more generally. The data from the interviews was analysed using a mixture of thematic and template analysis and coded using constructs from a sociotechnical model of information system implementation and adoption. Results: The findings show that despite severe delays to the nationally led (NPfIT) roll-out of EPRs and associated IT infrastructure within the UK, staff attitudes within the department were broadly positive about the potential of future EPRs to deliver efficiencies (e.g., improved workflow within the department, reduced reliance on paper-based systems). One of the main influences on attitudes towards the type of EPRs that should exist within outpatients was prompted by negative reactions to the way in which NPfIT systems had been managed and attempted to be introduced in the past. A strong commitment to end-user involvement in EPRs design, together with a rejection of NPfIT, appears to have shaped attitudes towards future expectations of the adoption of new EPRs within the department. In addition, staff do not believe that a rapid change to ‘paperless’ working is likely to be possible. Conclusions: Our findings provide further evidence that there is a need to treat the implementation of EPRs not simply as an exercise in technical system delivery, but as a larger process of sociotechnical systems change. We conclude the paper with some guidelines, the aim of which is to provide guidance regarding EPRs implementation and adoption informed by sociotechnical principles and ideas. [Copyright &y& Elsevier]

This paper reports on the findings of an English Department of Health funded study that mapped out examples of integrated impact assessment (IIA) activity, mainly in the UK. Approximately 350 regional and local organisations that have policy and policy implementation roles were contacted via e-mail and from these, 77 telephone interviews were carried out. The interviews revealed 21 examples of IIA being used or developed within the UK. The 77 interviews also generated a rich discussion about the use, efficacy and future development of IIA.Although the findings indicate little IIA activity in the UK, discussions with interviewees suggest that there is growing receptiveness to integrating different forms of assessment into a single assessment process. In part this appears to be driven by sustainable development objectives, both at a strategic and at a local level. In part receptivity to IIA may also be driven by a growing interest in health impact assessment (HIA). There are advocates of the need to integrate health criteria more fully into other forms of impact assessment.The study also highlights the challenges involved in trying to develop IIA methods that are adaptable, flexible and tailored to the different needs of policy-makers and planners. [Copyright &y& Elsevier]