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Book. It took such a long time, often to get
absolutely nowhere,…’ [GP11].
Some GPs noted that the incentive they
received for working with the system did not meet
their expectations. For example, a GP said:
‘…, if you added up all that extra doctor time, I
am not really sure if, the money that we get gets
anywhere near the actual time we put in’ [GP5].
Another important point mentioned by the
interviewees was that although the approach of
being paid for using the system might help to
develop practices, it is not really an appropriate
method for encouraging clinicians. When they were
asked to explain further, a GP who had decided to
stop using the system said:
‘…, there are times when incentives are of
limited use because of there isn’t the capacity to
absorb it. It doesn’t matter what incentive is given
it can’t be done’ [GP13].
Another approach suggested for encouraging
clinicians was convincing them that there are
benefits for both clinicians and patients. Both
consultants and GPs noted that the system should
bring some benefits for its users. One of the
consultants said:
‘The only way you can persuade people to use
information systems is to prove it is useful’
[Consultant1].
In support of this, another consultant added:
‘Consultants have to be convinced of the
benefits of an electronic booking system, they have
to see that it’s at least as good as what we currently
have or better’ [Consultant3].
Obviously, an example of an information
system being useful could be the ability of the
system to make the clinicians’ job easier by saving
their time. One of the consultants mentioned:
‘The only way is that you show it takes less time
to do Choose and Book in a way of accepting,
because all clinicians have to get letters and we
have to grade them and make decisions about them’
[Consultant3].
Concerning the benefits, it should be said that
clinicians seemed reluctant to use IT in their job if
there was no direct benefit or clinical use for it.
Although some GPs and consultants noted that
using this system would, for example, help GPs to
make sure that appointments for their patients were
available when they were leaving GP surgeries,
others saw little or no value in using the system by
clinicians. For instance, a GP said:
‘From our point of view, I don’t really see any
from the doctors’ point of view, I don’t see any
great advantages’ [GP5].
Some GPs noted that the process of
electronically choosing clinics and booking
appointments is not regarded as a clinical task, but
it is an administrative task. A GP mentioned:
‘I don’t think there is any way you will
encourage doctors to do administrative work, now
using IT for clinical issues is different altogether…
but if there is no clinical relevance to a doctor you
will not get them to do it’ [ GP7].
With regard to showing benefits, some
consultants noted that the benefits of an
information system should not be limited to
benefits for clinicians, and they might be happy to
use the system if there were benefits to the patients
and in the healthcare settings. A consultant
suggested that:
‘The benefit does not have to be to them, it may
be a benefit to a patient, and it may be a benefit to
the hospital. You have to demonstrate a benefit’
[Consultant1].
Similarly, a GP said:
‘when you go on Choose and Book I get
appointments for people in like 2 weeks or 1 week,
very quickly so that’s a good incentive’ [GP12].
Apart from the factors mentioned above, a
consideration of the technical issues was of great
importance to encourage clinicians to use the
system. For example, reliability was a main
technical feature that could be both encouraging
and discouraging. A consultant mentioned:
‘You implement it and then you show that it
works. So, the first problem you get, people will say
“oh, it won’t work”, or “we can’t use it”, or “it
takes too long”’ [Consultant6].
The consultants generally used the paper-based
system of accepting, rejecting or directing the
referrals, and at the time of the interview they had
no access to the system. However, some of them
were interested to try the system to see whether
there would be any benefit for them or check the
system to make sure about the reliability of it.
Some consultants noted that a factor influencing the
decision whether or not to use Choose and Book
could be certainty about the reliability of this
system. In relation to this, a consultant said:
‘I think there is a certain amount of uncertainty
as to how robust the Choose and Book system is.
People are just not sure that it will work. I think
that would be one thing’ [Consultant3].
Similarly, to indicate the importance of
reliability in encouraging clinicians, a GP said:
‘I think if it worked more often, if the system
didn’t keep failing, then we would use it more often
THE NATIONAL PROGRAMME FOR IT (NPFIT) IN ENGLAND - How Can Clinicians be Encouraged to Use the
Choose and Book Service?
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