Patient Safety in Community Care: e-health systems and the Care of the Elderly at Home

Handbook of Research on Patient Safety and Quality Care through Health Informatics

This chapter reviews a number of technologies used for remote care: telecare, telehealth, telemedicine, electronic patient record systems, and technologies to support mobile working.


The increasing number of elderly people in need of health and social care is putting pressure on current services to develop better ways of providing integrated care in the community. It is a widely held belief that e-health technologies have great potential in enabling and achieving this goal. This chapter reviews a number of technologies used for this purpose: telecare, telehealth, telemedicine, electronic patient record systems, and technologies to support mobile working. In each case, technocentric-design approaches have led to problematic implementations and failures to achieve adoption into the routine of delivering healthcare. An examination of attempts to implement major changes in the service delivery of integrated care shows that e-health technologies can be successfully implemented when they are seen as an intrinsic part of the creation of a complete system. However, the design process required for successful delivery of these services is challenging; it requires sustained and integrated development work by clinical staff and technologists coordinating their work on process changes, organisational developments, and technology implementations.

Patient Safety in Community Care: e-health systems and the Care of the Elderly at Home Ken Eason

Link to IGI Global

Eason K. D. and Waterson P.E Patient Safety in Community Care: e-health systems and the care of the elderly at home In Michel V., Gulliver S., Rosenorn-Lang D. and Currie W. (eds) Patient Safety and Quality Dimensions of Health Informatics. IGI Global 198-213

The Implications of e-health System Delivery Strategies for Integrated Healthcare: Lessons from the UK & Elsewhere


This paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care.

Four technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was conducted in England to examine the human and organizational implications of systems implemented by these four strategies. Results were used from evaluation reports of two systems delivered as part of the NPfIT (National Programme for Information Technology) and from user responses to systems delivered in two local health communities in England. In the latter study 40 clinical respondents reported the use of systems to support integrated care in six healthcare pathways.

The implementation of a detailed care record system (DCRS) in the NPfIT was problematic because it could not meet the diverse needs of all healthcare agencies and it required considerable local customization. The programme evolved to allow different systems to be delivered for each local health community. A national Summary Care Record (SCR) was implemented but many concerns were raised about wide access to confidential patient information. The two technical strategies that required looser forms of coupling and were under local control led to wide user adoption. The systems that enabled data to be transferred between local systems were successfully used to support integrated care in specific healthcare pathways. The portal approach gave many users an opportunity to view patient data held on a number of databases and this system evolved over a number of years as a result of requests from the user community.

The UK national strategy to deliver single shared database systems requires tight coupling between many users and has led to poor adoption because of the diverse needs of healthcare agencies. Sharing patient information has been more successful when local systems have been developed to serve particular healthcare pathways or when separate databases are viewable through a portal. On the basis of this evidence technical strategies that permit the local design of tight coupling are necessary if information systems are to support integrated care in healthcare pathways.


  • Links between electronic patient databases and healthcare agencies are defined in terms of tightness of coupling, range and scale.
  • The English Detailed Care Record System was unable to serve the diverse needs of healthcare agencies and was not successfully deployed.
  • Tight coupling was successfully deployed at a local level between agencies engaged in integrated care in healthcare pathways.
  • Widespread uptake was also found when portal systems were deployed that permitted viewing of a range of patient databases.
  • Adoption of patient databases was greater when there was middle-out design and technical strategies delivered looser forms of coupling.

Link to PDF

Science Direct Link

Eason K.D. and Waterson P.E. (2013) The Implications of e-health system delivery strategies for integrated healthcare: lessons from the UK and elsewhere. International Journal of Medical Informatics. 85(5) 96-106 Doi:10.1016/j.ijmedinf.2012.11.004

A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery

Evidence of outcomes across multiple uses of video conferencing in health and social care delivery – a socio-technical perspective

Video conferencing in care delivery telemedicine socio-technical v-connect Adam Hoare

Use of Video Connection Platform in Multiple Verticals of Care Delivery

Care and support services need to respond to the rapidly changing demands of the population and available resources. The authors will present evidence that video conferencing can underpin many of the aspirations for future care delivery. However, if the necessary scale and pace are to be achieved a new model for evidence generation needs to be found. Using the experience of deploying video across health and social care a new model of evidence generation will be proposed based on a socio-technical approach where complexity and human capabilities are features of the intervention. A practice-based approach utilising action research will be used. The model will focus on four dimensions that are key to the success of an intervention using video: Practice, Outcomes, Technology and Evidence. Addressing the interactions between these four dimensions promotes a system that can evolve services that, in cooperation with the video technology platform, can satisfy changing care demands

The effects of current economic and demographic pressures on care and support systems are well documented. The need to do more with less is an established requirement of new models of care. However, there are significant barriers to the innovation of new ways of working in care delivery. Some of these barriers will be described through the experiences of one of the authors (AH) in deploying video conferencing to support people in their own homes or in a care environment.

The current use of video in care delivery is predominantly clinician-to-clinician communication between care organisations. Established examples are stroke or cancer networks. When developing a strategy for deploying a video intervention targeted at people in a residential environment it soon became clear that there was not a precedent to follow. In terms of Porter’s Five Forces the intervention was neither a new entrant to an industry that already exists or a substitute for a current product. Clearly any adoption of the video approach was going to disrupt internal systems in the care organisation and result in changes to practice. From a resources and capabilities point of view any strategy to deploy video requires close collaboration between the resources of the care organisation and the video service provider. This is a challenging engagement for care providers as they are more accustomed to transactional approaches where products or services are bought to a specification. Hence, each video deployment required sensitivity to the resources and capabilities of the customer and a collaborative approach to lowering the barriers to use of the technology. For example, modifying the user interfaces of the video conferencing equipment could lower some barriers and this has been done extensively to improve the experience of the people receiving care and of the clinicians providing it.

A further challenge to any deployment of video conferencing is the initial modelling of the economic benefits. As each deployment creates a network of contacts there is no template for a specific intervention. Within health care, each disease, e.g. diabetes, has its own ‘silo’, i.e. has its own care pathway, its own specialists, seeks its own technical support and is evaluated in terms of its ability to meet disease-specific outcomes. Engaging with a particular silo is very dependent upon the context of the engagement and each deployment raises its own challenges. Therefore, before video can be deployed in the residential environment its benefits and cost effectiveness within current siloes of care have to be proved.

IGI Global Link

Hoare, Adam and Ken Eason.  A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery. IJSKD 6.2 (2014): 36-52. Web. 2 Nov. 2017. doi:10.4018/ijskd.2014040103