Core Unit for Medical Statistics and Informatics, Medical University of Vienna, 1090 Vienna, Austria.
Int J Med Inform. 2010 Mar;79(3):211-22. doi: 10.1016/j.ijmedinf.2009.12.002. Epub 2010 Jan 15.
National electronic health record programs are frequently associated with a number of problems. In view of their long duration and costs, efficient implementation of the programs with due regard given to the conclusions drawn thus far would be a meaningful goal from the economic point of view. In the present report we analyze programs from various countries with regard to the problems documented therein and derive, on a cross-country basis, the most common critical aspects of national electronic health record programs. These aspects should be given special attention in the implementation of future national electronic health record programs. Furthermore, measures which have proven to be useful in coping with the respective problems in individual countries will be suggested for each critical area.
Five countries were selected in which (a) programs for a national electronic health record system exist since at least 5 years, (b) the planned electronic health record systems encompass various approaches of implementation, and (c) pilot projects have already been conducted. The programs of these countries were analyzed on the basis of project reviews and audits with reference to the problems documented during their implementation. These were abstracted and standardized into cross-country categories which, in turn, were grouped into critical areas.
From the analysis of national electronic health record programs from England, Germany, Canada, Denmark and Australia, the following frequently involved critical areas were derived: (a) acceptance and change management, (b) demonstration of benefits and funding, (c) project management, (d) Health-policy-related goals and implementation strategy, (e) basic legal requirements, particularly in the field of data protection.
The analysis shows that similar critical areas exist in the various countries. Strategic, organizational and human challenges are usually more difficult to master than technical aspects. The measures used thus far to deal with the critical areas are selective approaches towards resolving individual problems. For the future it would be desirable to set up a comprehensive method that provides support in the complete process of implementing national electronic health record programs and hereby covers all critical areas identified within this paper.
国家电子健康记录计划通常会伴随许多问题。鉴于其持续时间长且成本高，如果能从经济角度出发，以有效且合理的方式实施这些计划，将是一个有意义的目标。在本报告中，我们分析了来自不同国家的计划，并根据其中记录的问题，得出了国家电子健康记录计划中最常见的关键方面。在实施未来的国家电子健康记录计划时，应特别关注这些方面。此外，我们还针对每个关键领域提出了在个别国家应对各自问题时已被证明有用的措施。
选择了五个国家，这些国家（a）至少有 5 年的国家电子健康记录系统计划，（b）计划中的电子健康记录系统涵盖了各种实施方法，以及（c）已经开展了试点项目。根据项目审查和审计，对这些国家的计划进行了分析，参考了实施过程中记录的问题。这些问题被抽象和标准化为跨国类别，继而又被分为关键领域。
通过对英国、德国、加拿大、丹麦和澳大利亚的国家电子健康记录计划进行分析，得出了以下几个经常涉及的关键领域：（a）接受和变更管理，（b）效益和资金证明，（c）项目管理，（d）与卫生政策相关的目标和实施策略，（e）基本法律要求，特别是在数据保护领域。
分析表明，不同国家存在类似的关键领域。战略、组织和人力方面的挑战通常比技术方面更难应对。迄今为止，用于解决关键领域的措施是针对个别问题的选择性方法。未来，最好建立一种全面的方法，为实施国家电子健康记录计划的整个过程提供支持，并涵盖本文中确定的所有关键领域。
