Motulsky Aude, Usher Susan, Lehoux Pascale, Régis Catherine, Reay Trish, Hebert Paul, Gauvin Lise, Biron Alain, Baker G Ross, Moreault Marie-Pierre, Préval Johanne, Denis Jean-Louis
School of Public Health, Université de Montréal, Montreal, QC H3N 1X9, Canada.
Research center, Academic health center of the Université de Montréal, Montreal, QC H2X 0C1, Canada.
J Am Med Inform Assoc. 2025 Aug 1;32(8):1286-1298. doi: 10.1093/jamia/ocaf077.
The digitalization of health records stands to improve decision-making at clinical, administrative, and policy level. Efforts follow various paths and are closely intertwined with health system and organizational configurations. Problems persist in both uptake and use. This study explores the digitalization trajectories of academic health centers (AHCs) to understand tensions between organizational and government strategies and their impact on digital development.
AHCs play a leadership role within health systems in data-driven improvement. This retrospective case study draws on documentary, observational, and interview data to compare digitalization efforts over 3 decades in 4 AHCs in the province of Quebec (Canada).
At system level, strategy shifted from supporting multilayered development that encouraged bottom-up initiatives in the first decade of the 2000s, to harmonizing clinical information systems in a highly prescriptive manner after 2010. AHCs experienced the shift differently according to concurrent impacts of health system restructuring, and internal choices around electronic health record (EHR) systems and implementation priorities. Digital maturity remained low in all 4 AHCs.
Coordination between system strategies and organizational strategies in AHCs was neglected in early digital development in Québec and improved only after an intense period of prescription and resistance. Confrontation highlighted tensions around different objectives at AHC and system level, competing missions within AHCs, and trade-offs between relying on commercial EHRs and developing publicly owned systems, all of which ultimately influence EHR implementation.
The different experiences of focal organizations with digitalization underline the importance of adapting national strategies and providing support to implementers, building on acquired strengths, and arriving at the right balance of guidance from the top and autonomy to develop innovative capacities.
健康记录数字化有助于改善临床、管理和政策层面的决策。相关工作沿着不同路径开展，且与卫生系统和组织架构紧密相连。在采用和使用方面仍存在问题。本研究探讨学术健康中心（AHC）的数字化轨迹，以了解组织战略与政府战略之间的矛盾及其对数字发展的影响。
AHC在数据驱动的卫生系统改进中发挥着领导作用。本回顾性案例研究利用文献、观察和访谈数据，比较了加拿大魁北克省4家AHC在30多年间的数字化工作。
在系统层面，战略从支持多层级发展（在二十一世纪头十年鼓励自下而上的举措）转变为在2010年后以高度规范性的方式协调临床信息系统。由于卫生系统重组的同时影响，以及围绕电子健康记录（EHR）系统和实施优先级的内部选择，AHC对这种转变的感受各不相同。所有4家AHC的数字成熟度仍然较低。
魁北克早期数字发展中忽视了AHC系统战略与组织战略之间的协调，直到经过一段严格规定和抵制的时期后才有所改善。对抗凸显了AHC和系统层面不同目标之间的矛盾、AHC内部相互竞争的任务，以及依赖商业EHR与开发公有系统之间的权衡，所有这些最终都会影响EHR的实施。
重点组织在数字化方面的不同经历凸显了调整国家战略并为实施者提供支持的重要性，要基于已有的优势，在自上而下的指导与发展创新能力的自主权之间找到恰当平衡。
