Purpose The purpose of this paper is to identify the best practices applied during the implementation process of a national electronic health record (EHR) system. Furthermore, the main goal is to explore the knowledge gained by experts from leading countries in the field of nationwide EHR system implementation, focusing on some of the main success factors and difficulties, or failures, of the various implementation approaches. Design/methodology/approach To gather the necessary information, an international survey has been conducted with expert participants from 13 countries (Denmark, Austria, Sweden, Norway, the UK, Germany, the Netherlands, Switzerland, Canada, the USA, Israel, New Zealand and South Korea), who had been playing varying key roles during the implementation process. Taking into consideration that each system is unique, with each own (different) characteristics and many stakeholders, the methodological approach followed was not oriented to offer the basis for comparing the implementation process, but rather, to allow us better understand some of the pros and cons of each option. Findings Taking into account the heterogeneity of each country's financing mechanism and health system, the predominant EHR system implementation option is the middle-out approach. The main reasons which are responsible for adopting a specific implementation approach are usually political. Furthermore, it is revealed that the most significant success factor of a nationwide EHR system implementation process is the commitment and involvement of all stakeholders. On the other hand, the lack of support and the negative reaction to any change from the medical, nursing and administrative community is considered as the most critical failure factor. Originality/value A strong point of the current research is the inclusion of experts from several countries (13) spanning in four continents, identifying some common barriers, success factors and best practices stemming from the experience obtained from these countries, with a sense of unification. An issue that should never be overlooked or underestimated is the alignment between the functionality of the new EHR system and users' requirements.

Abstract-The highly competitive global environment of the last few decades has urged companies to rely on Information Systems (IS) in order to improve customer service, reduce costs and increase productivity. In that direction, Enterprise Resource Planning (ERP) systems are being used as significant strategic tools that provide competitive advantages and lead to operational excellence. Despite that, ERP implementation projects are complicated, costly and include high failure risks. The present study aims (a) to develop and (b) empirically test a conceptual framework that investigates the factors affecting ERP system effective implementation in Small and Medium Enterprises (SMEs). The examination of the conceptual framework was made with the use of a newly-developed structured questionnaire that was distributed to a group of Greek SMEs. After the completion of the research period, 159 usable questionnaires were returned. The reliability and the validity of the questionnaires were thoroughly examined, while research hypotheses were tested using the "Structural Equation This work was not supported by any organization.According to Garg and Garg [8], this "enables the decisionmaking process to be timely, consistent and reliable across organizational units and geographical locations" (p. 424).ERP implementation has various benefits throughout the organisation: elimination of redundant information, drastic declines in inventory, reduction of production cost, better understanding of the changing customer needs, more efficient management of the extended network of suppliers and customers, increased productivity, improved response time, and decreased production cycle [5] However, ERP implementation requires considerable financial resources, while the whole implementation project is considered complex, lengthy, and quite challenging [9] [ 1 3 ] . A s a r e s u l t , t h e s u c c e s s r a t e o f s u c h p r o j e c t s i s considered to be quite disappointing [14] [15] [16]. More specifically, Samuel and Kumar [17], argue that the success rate is, only, around 50%, while approximately 90% of ERP implementation projects are late, or over budget. On the same vein, Umble and Umble [18] reported failure rates between 50% and 75%. Therefore, additional empirical studies are necessary in order to assist companies in increasing the success rates of ERP implementation projects.Under that context, the aim of the present study is twofold: (a) develop an original conceptual framework (research model) examining the impact of various research factors on ERP implementation success, (b) empirically test that framework, using data from Small and Medium Enterprises (SMEs) located in Greece (empirical research).(a) The development of the conceptual framework was based on two methodological steps: firstly, a review of the literature identified the factors that were used by previous studies as antecedents of ERP implementation success; secondly, a panel of experts was used in order to discuss these factors and provide a list of the most si...

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The deployment of Information and Communication Technology (ICT) in the health care sector and, especially, in hospitals offers great potential for improving the quality of services and reducing organizational expenses. This paper focuses on the utilization of ICT in the Greek health sector and, more specifically, on the use of Electronic Health Record (EHR) in the context of an Integrated Health Information System (IHIS). Extensive reference is also made to the relevant literature concerning ICT adoption to other developing countries in the Americas, Europe and Australia. A thorough description of ICT adoption and the steps that have been made towards the IHIS implementation in Greece are provided, while some suggestions regarding the current status of the use of EHR in Greece are made, taking into account the experience of adopting such systems in the other countries.