Introduction: The UK Government's information technology (IT) strategy for the NHS1 proposed developing an Electronic Patient Record (EPR) system for acute hospitals. Potential benefits include improved medical record keeping2 and reduced medication-related adverse events3. The importance of user opinions in determining the acceptance of systems such as EPR into everyday work has been highlighted4. As yet there are no reports in the literature of in-depth research studies seeking the opinions of hospital pharmacy employees in relation to EPR systems. This paper describes the development of a methodology to investigate the effect of EPR on the working patterns of hospital pharmacy employees, and explore their experiences and views about the system.

Methodological development: A case study approach has been developed, comprising a series of four cases. Each "case" is the pharmacy department of an acute NHS hospital Trust, at varying stages of implementation and use of EPR. Data are collected through direct observation, interviews, focus groups and documentary analysis. The use of data triangulation and methodological triangulation should develop converging lines of enquiry, making findings and conclusions more robust. As part of methodological development, a preliminary study has been conducted, the aims of which were to (i) pilot data collection through direct observation using "participant as observer", (ii) pilot the analysis of qualitative data arising from observation, and (iii) develop and pilot a tool for the analysis of documentary evidence.

Pilot study: The pilot study was conducted in a teaching hospital in North West England. Initial unstructured observations within the pharmacy department highlighted aspects for more focussed observations. These included observation within specific physical areas of the pharmacy department, and of individual members of staff who were "shadowed", in particular where their work took them to other areas of the hospital, for example on ward visits. Qualitative observational data were captured through handwritten notes. Ongoing data analysis will be used to direct data collection at the main case study sites. Trust documents provided information about the pharmacy department, and the IT systems currently utilised by pharmacy department personnel. Two different approaches to their analysis were trialed, based on procedures identified by a review of the literature.

Discussion: Implementation of an EPR system has the potential to profoundly affect the structure and functioning of a health care organisation, the work life of its employees, and the cost and quality of the services it provides. The study reported in this paper represents the development of a methodology capable of evaluating this complex process. Collection and analysis of direct observational data identified the systems used by pharmacy personnel in their work, how these systems are used, with preliminary views and opinions. These findings were able to be contextualised with information extracted using the finalised documentary analysis protocol.

References
(1) Department of Health. Delivering 21st Century IT Support for the NHS. National Strategic Programme. 1-26. 2002.
(2) The Audit Commission. Setting the Records Straight. A Study of Hospital Records. 1-68. 1995. London.
(3) Bates DW, Gawande AA. Patient Safety: Improving Safety with Information Technology. Journal of the American Medical Informatics Association 2003; 348:2526-2534.
(4) Kaplan B. Evaluating informatics applications - some alternative approaches: theory, social interactionism, and a call for methodological pluralism. International Journal of Medical Informatics 2001; 64:39-56.