Bottom‐up or top‐down?

Abstract

The multiple case study approach has been used as the research method, and data has been collected in Ireland and Israel by interviews and analysed using text coding methods. Findings: Factors elicited in the literature were generally corroborated, yet the salient factor on the localized perspective appears to be the degree of centralisation of the healthcare services; while different factors affected the national perspective. In summary, it seems that Israel is more ready for national EHR implementation than Ireland due to the high level of computerization and high levels of integration of primary and secondary care patient data. Research implications and value: Contribution to research is in the definition of a national EHR, the illustration of various levels of analysis and their relative impacts on EHR adoption, the analysis framework, and by showing that EHR adoption is a top-down, change management process. Practical implications: EHR adoption should be driven by a powerful actor in the healthcare sector addressing the need for a high level of integration within and between care levels, while focusing on clinicians' requirements. Technological and legislative infrastructures are mandatory for establishing a national EHR.

Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability

“…They are most often vendor-neutral, compared to the vendor-mediated tools that connect organizations using the same EHR vendor [14], and HIOs provide technical capability and governance frameworks for data exchange [15,16]. In the United States High [21] Moderate [52,104] High [58,106] High [72,109,110] High [87,114]…”