Understanding contrasting approaches to nationwide implementations of electronic health record systems: England, the USA and Australia.

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

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.

Citation

MORRISON, Z, ROBERTSON, A., CRESSWELL, K., CROWE, S. and SHEIKH, A. 2011. Understanding contrasting approaches to nationwide implementational of electronic health record systems: England, the USA and Australia. Journal of healthcare engineering [online], 2(1), article ID 203059, pages 25-41. Available from: https://doi.org/10.1260/2040-2295.2.1.25

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2010
• Online Publication Date: May 31, 2011
• Publication Date: May 31, 2011
• Deposit Date: Aug 25, 2020
• Publicly Available Date: Aug 25, 2020
• Journal: Journal of healthcare engineering
• Print ISSN: 2040-2295
• Electronic ISSN: 2040-2309
• Publisher: Hindawi
• Peer Reviewed: Peer Reviewed
• Volume: 2
• Issue: 1
• Pages: 25-41
• DOI: https://doi.org/10.1260/2040-2295.2.1.25
• Keywords: Electronic health records; Implementation; Information technology; International approaches
• Public URL: https://rgu-repository.worktribe.com/output/963178