Table 1 Description of the properties of the nationally procured type of software that was the focus of our investigation

Developed by iSOFT in India and implemented by the Computer Sciences Corporation as part of England's national strategy

The system was developed as it was being implemented and had releases with increasing capabilities that were implemented consecutively

In the initial release, the system and paper processes were run in parallel as system capabilities were limited including clinical notes and requesting

The second release replaced the existing Patient Administration system but this was only achieved in one hospital during our research