Bottom-up or top-down? A comparative analysis of electronic health record diffusion in Ireland and Israel

Purpose The limited success of electronic health records (EHRs) implementation in the healthcare services in general, and a national EHR in particular, requires better understand and documentation of the current drivers and inhibitors of EHR adoption, together with a definition of a national EHR. This paper aims to address these issues. Design-methodology-approach Factors affecting EHR adoptions are elicited from extant literature and the stakeholder-actor framework is used as the theoretical framework. The multiple case study approach is used as the research method, and data are collected in Ireland and Israel by interviews and analysed using text coding methods. Findings Factors elicited in the literature are generally corroborated, yet the salient factor on the localized perspective appears to be the degree of centralization of the healthcare services; while different factors affect the national perspective. In summary, it seems that Israel is more ready for national EHR implementation than Ireland due to the high level of computerization and high levels of integration of primary and secondary care patient data. Research implications Contribution to research is in the definition of a national EHR, the illustration of various levels of analysis and their relative impacts on EHR adoption, the analysis framework, and by showing that EHR adoption is a top-down, change management process. Practical implications EHR adoption should be driven by a powerful actor in the healthcare sector addressing the need for a high level of integration within and between care levels, while focusing on clinicians' requirements. Technological and legislative infrastructures are mandatory for establishing a national EHR. Originality-value Data for this study are collected in two countries that represent different healthcare structures, one being highly centralized while the other is just the opposite. These differences provide an additional interesting lens through which factors affecting EHR adoption can be assessed. As far as we know, not many previous studies have compared EHR adoption across two diverse healthcare systems.