Understanding Contrasting Approaches to Nationwide Implementations of Electronic Health Record Systems: England, the USA and Australia

Zoe Morrison,Aziz Sheikh,Sarah Crowe,Kathrin Cresswell,Ann Robertson

doi:10.1260/2040-2295.2.1.25

Zoe Morrison, Aziz Sheikh + Show 3 more

Open Access

https://doi.org/10.1260/2040-2295.2.1.25

Copy DOI

Abstract

As governments commit to national electronic health record (EHR) systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes - ‘top-down’, ‘bottom-up’ and ‘middle-out’ - to review EHR implementation strategies in three exemplar countries: England, the USA and Australia. In comparing and contrasting three approaches, we show how different healthcare systems, national policy contexts and anticipated benefits have shaped initial strategies. We reflect on progress and likely developments in the face of continually changing circumstances. Our review shows that irrespective of the initial strategy, over time there is likely to be convergence on the negotiated, devolved middle-out approach, which aims to balance the interests and responsibilities of local healthcare constituencies and national government to achieve national connectivity. We conclude that, accepting the current lack of empirical evidence, the flexibility offered by the middle-out approach may make this the best initial national strategy.

Highlights

The implementation of electronic health record (EHR) systems is being pursued around the world in an attempt to improve the quality, safety and efficiency of affordable healthcare
We suggest that even allowing for disparities in the estimated per capita investments by governments, if the anticipated benefits of EHR systems were to be achieved, these investments could be perceived as good value for money
We acknowledge, be many years yet before we can draw firm, evidence-based conclusions about the implementations and resultant benefits, both anticipated and unanticipated, of the three national EHR systems reviewed in this paper

Summary

INTRODUCTION

The implementation of electronic health record (EHR) systems is being pursued around the world in an attempt to improve the quality, safety and efficiency of affordable healthcare. We seek to go beyond a detailed description of the experiences of deploying EHR systems to understand why a particular national implementation approach was initially adopted and how, if at all, this has needed to evolve in the light of early experiences and changing circumstances. We report that these three countries’ approaches are converging on what Coiera described as the middle-out approach, and consider the implications of the review for future work

APPROACHES TO IMPLEMENTING NATIONAL EHR SYSTEMS

Findings

DISCUSSION

CONCLUSION