Perception gaps between policy makers and users along the diffusion process of the ICRS

Anastasia Papazafeiropoulou, Reshma Gandecha, Christopher Atkinson


Diffusion of innovations is a complex and longitudinal process, which in the case of individual adopters is mainly concerned with the process of decision making towards the adoption or rejection of the innovation. In the case of innovation adoption by organisations, once the decision to adopt has been made, implementation does not always follow directly (Rogers, 1995). The complexity of the diffusion process is becoming higher as a number of individuals with different interests and agendas are part of this process.

In this paper the organisation under investigation is the UK National Health Service (NHS) and the adoption of the Integrated Care Record Service (ICRS). This service is one of the four key deliverables set out in the NHS IT procurement strategy “Delivering 21st century IT support for the NHS”, published in June 2002. ICRS is a portfolio of services covering the generation, movement and access to health records, which includes electronic prescribing in hospitals and workflow capacities to manage patients care pathways through the NHS. Its benefits include convenience, integration of care, improving outcomes using evidence, supporting analysis and improving efficiency (NHSIA, 1998). With estimates that 25% of nurse and doctor time is taken up collecting data and the potential increase in speed and efficiency of communication the benefits appear very straightforward with the promise of “seamless care” (NHSIA, 1998).

ICRS moves away from the model of a number of separate information systems based primarily around organisational structures to one in which care professionals in many organisations are provided access to the one patient integrated record service. The services will include access to records and the functionality needed to support clinical practice and the provision of social care. The ICRS, if realised, would have a powerful role in convening the necessary caregivers around the individual in need. ICRS incorporates concepts of both the organisation-specific Electronic Patient Records and also the cradle-to-grave Electronic Health Record and supersedes the Information for Health Strategy (NHS 1998).

Similarly to previous examples of “too good to be true” innovations that have the potential to revolutionary the every day work of adopters (Papazafeiropoulou, 2002), the ICRS implementation has not been as efficient as expected with electronic recording of clinical data being usually incomplete. Being an “authority innovation-decision” (Rogers, 1995) where the choice of its adoption or rejection has been made by a relatively few individuals in a system that possess power, status and technical expertise a number of barriers hiding the realisation of the government’s strategy (NHS 2002) have been reported. Its potential users mainly relate these barriers to lack of knowledge and trust to the new system and the inadequate training they receive. Although the decision to adoption the new system has been made and the government has put plans in place for the service implementation, potential users seem to lack essential knowledge about the new service and its functionality. Looking at the innovation decision process, which includes the stages of knowledge, persuasion, decision, implementation and confirmation, the potential users of ICRS appear to be at the first stages of the innovation decision process such as the stages of knowledge and persuasion. Policy makers on the other side are making plans for the system implementation, which is one of the latest stages of the process.

In this paper we examine how diffusion receivers (users, such as doctors or nurses) perceive the ICRS implementation in comparison to policy makers. We argue that there is a gap between the demand and the supply side of the diffusion process, which reveals a broad barrier in the ICRS implementation. We use primary and secondary data to capture the perceptions of both diffusers and diffusion receivers in order to get a better understanding of the ICRS diffusion process. Our aim is by drawing a clear picture of the process to identify existing barriers and bridge the perception gaps offering recommendations towards a more efficient implementation strategy. With the allocation of £2.3bn to fund this ICRS project (NHS 2002), we argue that there is renewed optimism and genuine interest to bridge the gap between strategy and realisation to implementation of ICRS (Firth P. 2003).


Firth P. (2003). Preparing for healthcare and social care integration: some current barriers to ICT based sharing of information, The British Journal of Healthcare Computing & Management June 2003 Volume 2003 Volume 20 Number 5

NHS (2002). The NHS explained [online] The NHS IM/T 21st Century Strategy accessed at,

NHSIA, (1998), An Information Strategy for the Modern NHS 1998-2005, A national strategy for local implementation, retrieved 29th Jan 2003 from

Papazafeiropoulou, A. (2002). A stakeholder approach to electronic commerce diffusion. Brunel University, London.

Rogers, E. M. (1995). Diffusion of innovations (fourth edition). New York: Free Press.