Policy Context and Legal Framework

The EHR implementation would lead to several benefits such as a significant costs reduction - due to fact that duplicate exams would be avoided - an improvement of the continuity of care facilitate by the possibility of sharing patient health history records among providers and across institutions, the merging and the consolidation of health databases, thus enhancing patient empowerment and supporting scientific research.

However, EHR implementation faces several challenges including interoperability, data privacy, safety and confidentiality, standardization but also complex socio-cultural and organizational issues. Several failed implementation initiatives in eHealth have been attributed to a non sufficient attention toward organizational changes leading to innovation. To address these issues, eHealth systems must be treated as ‘socio-technical’ applications. Successful EHR implementations and long term sustainability at a broad scale must consider political, organizational and social factors which are difficult to manage by policy and decision makers. The implementation of EHR at national level is mainly a political issue; the process starts with a political vision followed by a political decision, then by an implementation plan and finally by practical use.

Past experiences have shown that the political vision, as it progressively evolves along the process, results in a final implementation which is often far from the initial vision. EHR implementation is similar to the introduction of a major management innovation. The main phases of the project development would be: political decision, definition of objectives and conditions, negotiations for the technical object, adjustments following pilot implementations and finally, production level national and regional implementation.

Within this process, there are differences among the countries for what concerns models of governance, legislation and regulation needs, methods of communication and training, etc. In addition, being a dynamic and very complex process, EHR implementation involves a great number of actors including decision makers, health officers, engineers and users. EHR long term success and sustainability requires a deep cultural change where the main obstacle is the health professionals' resistance. Combining qualitative and quantitative methodologies, EHR-IMPLEMENT aims at making recommendations for policy, strategy and action plans for EHR national implementations in European countries as well as providing general lessons to be taken into account at the European policy level.