Value, Participation and Quality of Electronic Health Records in the Netherlands

Growing cost of health care, the gradual reorganization of health care on a free-market basis and patients evolving into health care consumers all prompt hospitals to gain competitive advantage by improving efficiency, quality of care, and customer friendliness. An electronic health record system (EHR) is one of the tools to achieve these goals. Hospitals are nevertheless lagging behind industry in implementing IT systems to support their core business processes. Eighteen case studies were conducted among Dutch hospitals to examine the EHR system implementation. Through seventy three interviews with key stakeholders, the relation between perceived value of the EHR, the degree of participation in the implementation process, and the resulting quality of EHR systems was investigated. The value that end users expect is not achieved within Dutch hospitals. It was found that no hospital had so far reached third generation EHR functionality, even though several hospitals are actively pursuing it. Innovation with respect to EHR systems in hospitals is limited because of a lack of capabilities, not because of a lack of participation. Extensive and ill-targeted end user involvement tends to delay decision making and exacerbates the mismatch between implementation goals and results. Quality issues focus on information quality in terms of completeness and system quality in terms of reliability. This study contributes in combining participation models with the technology acceptance model and the IS success models. Electronic Health Records can be evaluated with this combination and a prescriptive analysis has lead to practical advice to the Dutch Ministry of Health.