Comparing the Implementation of Electronic Patient Record (EPR) Systems in Germany and Norway. What are the key factors explaining differences in implementation of Electronic Patient Record systems in Germany compared to Norway?
BACKGROUND: Differences in the pace of implementation and degree of diffusion of Electronic Patient Record (EPR) systems can be observed between Germany and Norway. Whereas EPR systems are implemented nationwide in Norway, EPR implementations in Germany remain scattered at the regional level. A nationwide implementation has not yet been achieved. Considering that these differences exist, it is highly interesting to explore why this phenomenon occurs. OBJECTIVE: The aim of this study is to extract the key factors that explain differences in the implementation of EPR systems in Germany compared to Norway. The study aims to provide a starting point for further research on how to ensure success in EPR implementations. METHOD: By combining three research methods; a scoping review, an implementation evaluation and a descriptive comparison, this qualitative comparative study examined two cases in a cross-country comparison. A scoping review was performed in order to identify relevant literature and variables. An implementation evaluation was developed to obtain country-specific observations. Subsequently, these observations were compared by performing a descriptive comparison. The descriptive comparison was anticipated to result in one or more key factors. RESULTS: According to the assessed literature, differences in the pace of implementation and the degree of diffusion are a result of five key factors. These key factors are: (1) the degree of reservation towards EPRs from both society and from patients; (2) the efficiency and pace in political decision-making; (3) the presence of a clear national strategy, including strategy plans; (4) the presence of clear governance structures, including a clear allocation of responsibilities; and (5) the complexity and diversity of laws and regulations. CONCLUSION: The extracted key factors suggest that the government, including its regulatory power, has a relatively strong influence on EPR implementations. This study found that dissenting government measures are the main source of factors that explain differences in the implementation of EPR systems in Germany compared to Norway. Additionally, societal and patients’ reservations, at least in the past, seemed stronger in Germany than in Norway.