The goal of a national electronic health records integration system is to aggregate electronic health records concerning a particular patient at different healthcare providers' systems to provide a complete medical history of the patient. It holds the promise to address the two most crucial challenges to the healthcare systems: improving healthcare quality and controlling costs. Typical approaches for the national integration of electronic health records are a centralized architecture and a distributed architecture. This paper proposes a new approach for the national integration of electronic health records, the semi-centralized approach, an intermediate solution between the centralized architecture and the distributed architecture that has the benefits of both approaches. The semi-centralized approach is provided with a clearly defined architecture. The main data elements needed by the system are defined and the main system modules that are necessary to achieve an effective and efficient functionality of the system are designed. Best practices and essential requirements are central to the evolution of the proposed architecture. The proposed architecture will provide the basis for designing the simplest and the most effective systems to integrate electronic health records on a nation-wide basis that maintain integrity and consistency across locations, time and systems, and that meet the challenges of interoperability, security, privacy, maintainability, mobility, availability, scalability, and load balancing.

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Implementing Electronic Health Records (EHRs) in primary healthcare has the potential to improve the population health, and to enhance the overall healthcare system of the country. Current policy initiatives in the Kingdom of Saudi Arabia (KSA) are attempting major reforms in primary care with EHRs as a key component. Understanding human factors involved in the implementation process of technology is crucial for its successful implementation. The aim of this paper is to support current policy initiatives by investigating and identifying factors that are likely to affect primary care physicians' acceptance of EHRs. Factors were identified based on extensive literature reviews and empirical findings. Three main stages of literature review were conducted: (1) factors influencing user adoption of IT, (2) factors affecting physician adoption of EHR, and (3) findings of relevant studies pertaining EHR adoption by physicians in the KSA. As a result, we developed an integrated framework of eight factors that were proven to have a significant direct influence on physicians' acceptance of EHRs: attitude, perceived usefulness, perceived ease of use, social influence, computer self-efficacy, perceived threat to physician autonomy, confidentiality concerns, and physician participation. The proposed framework will be of great potential to policy makers to make the transition to EHRs run smoothly.