Barriers to the use of e-health technology in nurse practitioner-patient consultations

Purpose: This paper examines primary care nurse practitioners' (NPs) use of information available via e-health technology (EHT) within consultations. It explores which information resources NPs use in clinical decision making, their comparative use of electronic versus paper-based and human information resources, the reasons behind their choices and how the use of different resources impacts on patient interactions. Methods: Semi-structured interviews were under-taken with 12 NPs recruited from 11 different general practitioner (GP) practices and five primary care trusts (PCTs) within the West Midlands South Strategic Health Authority, UK. Findings: The key finding was that for NPs an effective information resource is one that provides sufficient information, to generate a patient management plan rapidly. Speed, familiarity and trust are vital ingredients for regular use. Paper-based information resources therefore retain a significant role, and together with human information resources are still more frequently used than most electronic, and particularly web-based, resources. The latter are not yet well established within the context of patient consultations. Electronic clinical support, systems (such as Mentor, PRODIGY) and GPnotebook) are regularly used, however, because they are often linked electronically to patient records, and generate brief information, in a form accessible to both nurses and patients. By contrast, searching, for information from web-based resources was considered time-consuming, technically difficult and disruptive to patients. All NPs reported some negative effects on patients of using computers: mostly disrupted rapport and longer consultations. However, the majority had developed ways of working to, overcome these difficulties and that helped them to maintain, their patient-centred focus. Conclusions: Study NPs had receivcdl only very limited information technology (IT) training, but nevertheless were enthusiastic about computer use. This suggests that with further training they could adapt their practice to embrace more EHT, which would enhance their ability to be more autonomous and to base their practice on sound clinical evidence.