National Initiatives to Build Healthcare Information Infrastructures

Significant sums of money are invested in information systems (IS) initiatives in the healthcare sector all over the world. Most countries have implemented Electronic Patient Record (EPR) systems, which are clinical IS that support documentation of examination, treatment, and care of patients. EPR systems are expected to raise the quality of care, reduce medical errors, cut waiting time and render the operation of healthcare more effective. Many of the expected benefits from EPR systems hinge on their ability to facilitate information sharing between healthcare providers. Consequently, many governments and healthcare providers have formulated national strategies to achieve a fully integrated information infrastructure building on interoperable EPR systems. In this paper we describe how the health authorities in Denmark have attempted to achieve interoperability through standardization of EPR systems in the so-called B-EPR initiative (i.e. Basic Structure for EPR).The initiative eventually failed and we argue that the main reason for this was too high ambitions along three dimensions: the geographical reach, the functional scope, and the temporal span. We argue that a critical look at the ambition level and associated strategies may contribute to formulating more modest targets. It is worthwhile to focus on defining strategies that specify how small and manageable initiatives can be extended and built on.