Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation

The introduction of electronic health records (EHRs) lies at the heart of many international efforts to improve the safety and quality of healthcare. England has attempted to introduce nationally procured EHR software--the first country in the world to do so. In this qualitative comparative case study tracing local developments over time we sought to generate a detailed picture of the implementation landscape characterising this first attempt at implementing nationally procured software through studying three purposefully selected hospitals. Despite differences in relation to demographic considerations and local implementation strategies, implementing hospitals faced similar technical and political challenges. These were coped with differently by the various organisations and individual stakeholders, their responses being shaped by contextual contingencies. We conclude that national implementation efforts need to allow effective technology adoption to occur locally before considering larger-scale interoperability. This should involve the allocation of sufficient time for individual users and organisations to adjust to the complex changes that often accompany such service re-design initiatives.