Table 1 Summary of recommendations for formative evaluation of large-scale health information technology [17]

Before-during-after study designs are ill suited to explore large-scale electronic health record implementations due to shifting policy landscapes and over-optimistic deployment schedules. They also do not sufficiently take local views and interpretations into account.

Formative evaluations need to consider this changing landscape and explore stakeholder perspectives to gain insights into how local actors understand and implement change.

Sociotechnical approaches can help to conceptualise the interactions between people, technology and work processes. They can help to draw a more nuanced picture of the implementation and adoption landscape than traditional positivist paradigms.