Implementation of a nationwide electronic health record (EHR)

Abstract

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.

Successfully implementing a national electronic health record: a rapid umbrella review

“…This was evident in the literature reviews which largely focused on studies conducted in the largely private health service in the USA where return on investment and productivity were important perceived benefits and incentives 50 , 51 , 56 . Additionally whilst the governance approach was identified as important, a successful approach in one country cannot necessarily be replicated in another, as occurred in the UK where the top-down approach successfully employed in the Netherlands resulted in disengaged healthcare organizations in the UK 22 . Therefore, these factors need to be employed with consideration of the national context and in the Republic of Ireland this will also require close collaboration and communication across the co-existing public and private health sectors 64 , 65 , as well as with Northern Ireland (UK).…”

“…Despite the number of benefits which can be derived from these systems, challenges have been met in implementing a fully interoperable EHR between primary and secondary care 13 , 19 , often attributed to the implementation process as opposed to the product supplied by the EHR vendor 20 , 21 . Therefore, the implementation process is critical 22 and must be considered as an ongoing process beginning during procurement and continuing throughout each phase of design, development, testing, ‘Go Live’ and optimization.…”

Sairaanhoitajien valmiudet tiedonhallintaan sekä kokemukset potilas- ja asiakastietojärjestelmien tuesta työtehtäviin

“…Vaikutukset käyttöönotosta saadaan esiin usein vuosien viiveellä [16,21]. Tutkimustulokset osoittavat tietojärjestelmien käytön olevan yhteydessä kirjaamisen laadun paranemiseen ja lääkemääräysvirheiden vähenemiseen, mutta näyttöä vaikutuksista hoidon tuloksiin on vähän [5,12,[22][23][24].…”

“…Aineisto on lähes samansuuruinen kuin vuoden 2017 aineisto [25]. Vastaavaa kansainvälistä tutkimusta on tehty tietojärjestelmien käyttöönottojen yhteydessä [23][24].…”

Valtakunnallisten Kanta-palvelujen käyttöönotto apteekeissa ja kuntien julkisessa perusterveydenhuollossa vuosina 2010–2016

“…Suomessa sähköisten terveyspalvelujen kehittämistä on mallinnettu esimerkiksi sosioteknisen teorian mukaisesti Varkaudessa [31] ja ASSI-hankkeessa [32]. Käyttöönottoihin vaikuttavat kirjallisuuden mukaan useat tekijät [33][34][35]. Alueellisista ja paikallisista sote-tietojärjestelmien käyttöönotoista Suomessa löytyy julkaistua tietoa ainakin Turusta [30], Satakunnan Makropilotista [12][13][14], Helsingistä [7], Forssan seudusta [27], Satakunnasta [36][37][38], Kuopiosta [39], Keski-Suomesta [40], Tampereelta [20], Itä-Savosta [41], Varsinais-Suomesta [42], Varkaudesta [31] ja Sipoosta [43].…”