NHS Scotland’s Decision Support Platform: a formative qualitative evaluation

CONTEXT: The Scottish Government has identified computerised decision support as a strategic priority in order to improve knowledge management in health and social care settings. A national programme to build a pilot Decision Support Platform was funded in 2015. AIMS: We undertook a formative evaluation of the Decision Support Platform to inform plans for its national roll-out in primary care. METHODS: We conducted a series of in-depth semistructured interviews and non-participant observations of workshops demonstrating decision support systems. Participants were policymakers and clinical opinion leaders from primary care. As the Platform was in its early stages of development at the time of data collection, we focused on exploring expectations and drivers of the pilot decision support system tested in primary care. Our methodological approach had to be tailored to changing circumstances and offered important opportunities for realising impact through ongoing formative feedback to policymakers and active engagement of key clinical stakeholders. We drew on sociotechnical principles to inform data analysis and coded qualitative data with the help of NVivo software. FINDINGS: We conducted 30 interviews and non-participant ethnographic observations of eight stakeholder engagement workshops. We observed a strong sense of support from all stakeholders for the Platform and associated plans to roll it out across NHS Scotland. Strategic drivers included the potential to facilitate integration of care, preventive care, patient self-management, shared decision-making and patient engagement through the ready availability of clinically important information. However, in order to realise these benefits, participants highlighted the need for strong national eHealth leadership to drive a coherent strategy and ensure sustained funding, system usability (which stakeholders perceived to be negatively affected by alert fatigue and integration with existing systems) and ongoing monitoring of potential unintended consequences emerging from implementations (eg, increasing clinical workloads). CONCLUSIONS AND IMPLICATIONS: In order to address potential tensions between national leadership and local usability as well as unintended consequences, there is a need to have overall national ownership to support the implementation of the Platform. Potential local tensions could be addressed through allowing a degree of local customisation of systems and tailoring of alerts, and investing in a limited number of pilots that are carefully evaluated to mitigate emerging risks early.