Diffusion of Electronic Health Records and electronic communication in Norway
25 January 2011
accepted: 12 July 2011
16 December 2017 (online)
Objective: To assess the diffusion of Electronic Health Record (EHR) systems over time in Norwegian health care.
Methods: This study was based on a retrospective cross-sectional questionnaire survey. Questionnaires for three groups of responders were based on two validated questionnaires from prior studies, which were further customized through workshops. The questionnaires were sent to a random sample of 180 municipalities and 150 general practices in all 26 hospitals in Norway.
Results: The diffusion curves for EHR systems from 1980 to 2008 were established and analyzed. The most striking finding was the length of time from the availability of the first adequate EHR systems until full coverage was achieved in general practice and in hospitals. Diffusion of EHRs into nursing homes and maternal and child health centers started ten years later, and the diffusion for these centers has also been slow. In general practice the diffusion seems to follow the classical s-curve of diffusion. Costs and the increasing complexity of EHR systems were regarded by respondents as the most important challenges and concerns for the future. Resistance among health personnel was seen only as a small problem.
Conclusion: National strategic processes account for the slow diffusion and complexity of EHR systems in the health sector.
KeywordsElectronic health records - primary care - hospitals - general practice - nursing home - diffusion
- 1 Lærum H, Ellingsen G, Faxvaag A. Doctors’ use of electronic medical records systems in hospitals: cross sectional survey. BMJ 2001; 323 7325 1344.
- 2 Ellingsen G, Monteiro E. Big is beautiful: electronic patient records in large Norwegian hospitals 1980s-2001. Methods of Information in Medicine 2003; 42 (04) 366-370.
- 3 Castro C. Explaining International IT Application Leadership: Health IT 2009. The Information Technology and Innovation Foundation; Washington.:
- 4 Protti D. Comparison of information technology in general practice in 10 countries. Healthc Q 2007; 10 (02) 107-116.
- 5 Protti D. et al. Primary care computing in England and Scotland: a comparison with Denmark. Informatics in Primary Care 2006; 14 (02) 93-99.
- 6 Nohr C. et al. Development, implementation and diffusion of EHR systems in Denmark. International Journal of Medical Informatics 2005; 74 (2–4) 229-234.
- 7 Nøhr C. et al. Shared experience in 13 local Danish EPR projects: the Danish EPR Observatory. technology (EPR) 2001; 5: 6.
- 8 Henningsen T. EPJ-monitor, Annual report 2008. 2009 Directorate of Health.
- 9 Bower AG. et al. The diffusion and value of healthcare information technology. 2005. Rand Corp.;
- 10 Rogers E. ed. Diffusion of innovation. 4 th ed. 1995. Free Press; New York.:
- 11 Bassøe C. EDB i allmennpraksis. Journal of Norwegain Medical Association 1983; 103: 1270-1274.
- 12 Hasvold T. A Computerized Medical Record “The Balsfjord System”. Scandinavian Journal of Primary Health Care 1984; 2 (03) 125-128.
- 13 Nilsen J. A computerized medical record system for primary health care. Journal of the Norwegian Medical Association 1982; 102: 1285-1288.
- 14 Anderson JG, Jay SJ. Computers and clinical judgement: The role of physician networks. Social Science and Medicine 1985; 20 (10) 969-979.
- 15 Dobrev A. et al. Benchmarking ICT Use among General Practitioners in Europe: Final Report. Empirica: Bonn; 2008
- 16 Gans D. et al. Medical groups’ adoption of electronic health records and information systems. Health Affairs 2005; 24 (Suppl. 05) 1323.
- 17 Lium JT. et al. From the front line, report from a near paperless hospital: Mixed reception among health care professionals. Journal of the American Medical Informatics Association 2006; 13 (Suppl. 06) 668-675.
- 18 Lium JT, Tjora A, Faxvaag A. No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record. BMC Medical Informatics and Decision Making 2008; 8 (01) 2.
- 19 Lyng KM, Hildebrandt T, Mukkamala RR. From paper based clinical practice guidelines to declarative workflow management 2009:. Springer.;
- 20 Mabeck H. Electronisk medicinering i klinisk praksis. 2008. Aalborg universitet; Aalborg.:
- 21 Ministry of Health and Social Affairs: Elektronisk pasientjournal standardisering.. Arkitektur, arkivering og sikkerhet. [Electronic medical record system standardisation. Architecture, archiving and security]. Oslo: Green paper version 0.7 2000.
- 22 Johnsen J, Rotvold G. Analyse av kartleggingsdata for bruk av IKT i Helse-og omsorgsektoren. 2009