Objective: 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.
Method: 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.
Results: 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.
Conclusions: 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.
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