Fragidis Leonidas L, Chatzoglou Prodromos D
School of Engineering, Democritus University of Thrace , Xanthi, Greece.
Int J Health Care Qual Assur. 2018 Mar 12;31(2):116-130. doi: 10.1108/IJHCQA-09-2016-0136.
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.
目的 本文旨在确定国家电子健康记录（EHR）系统实施过程中应用的最佳实践。此外，主要目标是探索在全国范围内实施EHR系统领域的领先国家的专家所获得的知识，重点关注各种实施方法的一些主要成功因素和困难或失败之处。 设计/方法/途径 为收集必要信息，对来自13个国家（丹麦、奥地利、瑞典、挪威、英国、德国、荷兰、瑞士、加拿大、美国、以色列、新西兰和韩国）的专家参与者进行了一项国际调查，这些专家在实施过程中发挥了不同的关键作用。考虑到每个系统都是独特的，具有各自（不同）的特点和众多利益相关者，所采用的方法不是为比较实施过程提供基础，而是让我们更好地理解每个选项的一些优缺点。 发现 考虑到每个国家的融资机制和卫生系统的异质性，主要的EHR系统实施选项是中间向外的方法。采用特定实施方法的主要原因通常是政治性的。此外，研究表明全国范围内EHR系统实施过程中最重要的成功因素是所有利益相关者的承诺和参与。另一方面，医疗、护理和行政社区缺乏支持以及对任何变革的负面反应被视为最关键的失败因素。 原创性/价值 当前研究的一个优点是纳入了来自四大洲13个国家的专家，从这些国家获得的经验中识别出一些共同的障碍、成功因素和最佳实践，具有一种整体性。一个绝不能被忽视或低估的问题是新EHR系统的功能与用户需求之间的一致性。
