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. Design/methodology/approach: Factors affecting EHR adoptions were elicited from extant literature and the stakeholder/actor framework is used as the theoretical framework. The multiple case study approach has been used as the research method, and data has been collected in Ireland and Israel by interviews and analysed using text coding methods. Findings: Factors elicited in the literature were generally corroborated, yet the salient factor on the localized perspective appears to be the degree of centralisation of the healthcare services; while different factors affected 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 and value: 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.