Diffusion of Electronic Health Records and electronic communication in Norway.

OBJECTIVE: To assess the diffusion of Electronic Health Record (EHR) systems over time in Norwegian health care. METHODS: This study was based on a retrospective cross-sectional questionnaire survey. Questionnaires for three groups of responders were based on two validated questionnaires from prior studies, which were further customized through workshops. The questionnaires were sent to a random sample of 180 municipalities and 150 general practices in all 26 hospitals in Norway. RESULTS: The diffusion curves for EHR systems from 1980 to 2008 were established and analyzed. The most striking finding was the length of time from the availability of the first adequate EHR systems until full coverage was achieved in general practice and in hospitals. Diffusion of EHRs into nursing homes and maternal and child health centers started ten years later, and the diffusion for these centers has also been slow. In general practice the diffusion seems to follow the classical s-curve of diffusion. Costs and the increasing complexity of EHR systems were regarded by respondents as the most important challenges and concerns for the future. Resistance among health personnel was seen only as a small problem. CONCLUSION: National strategic processes account for the slow diffusion and complexity of EHR systems in the health sector.

Healthcare Information Framework.

CEN committee TC 251 Medical Informatics, has set up a project team charged with producing a European pre-standard ENV on Healthcare Information Framework (HIF). The HIF is based on abstraction from a specific information system architecture to a reference architecture and further to a conceptual architectural framework based on serving open, distributed and heterogeneous healthcare enterprises. To specify the suitable healthcare information system architecture modelling of the healthcare enterprise is required. As there is no one method serving all needs, the HIF gives guidance on what aspects to look at in selecting a suitable modelling method. It is expected that the work will be completed by early 1995.

Implementing security in computer based patient records clinical experiences.

In Norway, organizational changes in hospitals and a stronger focus on patient safety have changed the way of organizing and managing paper based patient records. Hospital-wide patient records tend to replace department based records. Since not only clinicians, but also other non-medical staff have access to the paper records, they also have easy access to all the information which is available on a specific patient; such a system has obvious 'side effects' on privacy and security. Computer based patient records (CPRs) can provide the solution to this apparent paradox if the complex aspects of security, privacy, effectiveness, and user friendliness are focused on jointly from the outset in designing such systems. Clinical experiences in Norway show that it is possible to design patient record systems that provide a very useful tool for clinicians and other health care personnel (HCP) while fully complying with comprehensive security and privacy requirements.