Health informatics as a tool to improve quality in non-acute care--new opportunities and a matching need for a new evaluation paradigm.

Whilst most health care is delivered to people living at home, the focus of innovation in health informatics concepts has been largely on acute hospitals. However, delivery of services in community settings, and often related to long-term conditions, is complex, and involves multiple professions and agencies, delivery of care in several locations including home settings, and individually tailored care for episodes lasting over long periods of time. This challenge is poorly supported by current information systems. However, computer-based record systems have a major potential to improve quality of care by enabling integrated care delivery through multi-professional electronic patient records, whilst also providing quality assurance processes. In turn, though, this requires a new evaluation paradigm. Firstly, the multi-disciplinary and holistic ideal of integrated care requires an as yet inadequately developed framework to give structure to assessment of the value and utility of the data recorded and the way in which they are processed and presented, mapped to clinical processes and to the views of consumers as prime stakeholders. Secondly, a deeper and longer-term evaluation philosophy is needed which does not stop after the initial confirmation of system functioning, but continues on with a deepening into the effects on the individual clinical services, and then on the host user organisation. This paper maps out the new paradigm, and suggests specific issues which merit practical research to reset evaluation and assessment tools to this new setting and viewpoints.