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Navigating large-scale EHR implementations in public health systems: Lessons learned and recommendations from a rapid
Louis Raymond1, Aude Motulsky2, Gregory Vial3
1Institut de recherche sur les PME, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
Health Informatics Journal
|May 28, 2025
Summary
Successful National Electronic Health Record (NEHR) implementation requires stakeholder engagement, institutional alignment, and adaptable technology. Participatory strategies and flexible governance enhance NEHR system sustainability and effectiveness.
Area of Science:
- Health Informatics
- Health Services Research
- Implementation Science
Background:
- National Electronic Health Record (NEHR) initiatives aim to improve healthcare delivery.
- Gaps persist between NEHR knowledge and practical implementation.
- Understanding implementation challenges is crucial for optimizing NEHR systems.
Purpose of the Study:
- To systematically synthesize empirical evidence on past NEHR initiatives.
- To identify critical gaps between NEHR knowledge and practice.
- To provide actionable insights for policymakers, health IT leaders, and practitioners.
Main Methods:
- Rapid review approach.
- Qualitative content analysis of empirical studies (2010-2024).
- Searched Scopus, PubMed, Medline, and CINAHL databases; 24 studies analyzed.
Main Results:
- Successful NEHR implementation depends on stakeholder engagement, institutional/cultural alignment, and technological standardization.
- Meaningful clinician involvement and adaptive leadership are key for adoption.
- Hybrid 'middle-out' approaches facilitate smoother transitions compared to rigid top-down methods.
Conclusions:
- NEHR deployments necessitate strategic decision-making, continuous stakeholder engagement, and flexible governance.
- Prioritize participatory implementation strategies and adaptive standardization for NEHR effectiveness.
- Mechanisms for iterative learning are essential for enhancing NEHR system sustainability.
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