1. Implementing national EHR strategies in Europe: organisational, social and political issues Laurence ESTERLE, MD,PhD INSERM U 750 ‘Medicine, Sciences, Health & Society’ Villejuif – France

2. Implementing national EHR strategies in Europe: organisational, social and political issues 1. New topics for Eurorec ? 2. Main issues and research topics 3. Next steps

3. Implementing national EHR strategies in Europe: organisational, social and political issues 1. New topics for Eurorec ?

4. National EHR Implementation  A radical innovation facing: Numerous technological issues But also political, organisational and social issues  Possible failures because of non-technical issues Social, cultural and organisational challenges at the core of EHR adoption Failures due to limited knowledge or consideration for these issues

5. National EHR Implementation  A socio-technical innovation  Requires management of change at all levels & dimensions

6. Organisational, social and political issues: New topics for Eurorec ?  European dimension Many European countries already engaged Lack of experience sharing and best practice exchanges  Eurorec scope and goals Dissemination of information based on European experiences Organisational, cultural and social issues  Complementary with existing projects : Q-Req project RIDE roadmap

7. Implementing national EHR strategies in Europe: organisational, social and political issues 2. Main issues and research topics

8. National EHR implementation: Political issues  Strategy: Political vision Political decision Management at the political level  Dynamic & very complex process Introduction of a major innovation Many actors involved Many changes during the process

9. National EHR implementation: Research topics on political issues  Governance of the system Decision process Institutional design Actors involved  Funding mechanisms & financial models  Accompanying legal and regulatory measures

10. National EHR implementation: Organisational issues  Impact on the National Healthcare system and its organisation  Changes in the healthcare practices  Changes in the role of the actors

11. National EHR implementation: Research topics on organisational issues  Management of organisational change  Involvement and participation of users: health professionals citizens

12. National EHR implementation: Social issues  Potential conflict with cultural or social values, eg: Radical cultural change of healthcare tools Change in respective roles of health professionals & patients Empowerment of patients and citizens

13. National EHR implementation: Research topics on social issues  Identification of controversies  User acceptance and/or resistance

14. Implementation of national EHRs strategy: Organisational, social and political issues 3. Next steps

15. Next steps: National and European level  For decision makers: Encouragement & funding of studies and projects on social aspects of EHR implementation Experience sharing and benchmarking of best practices between Member states  For researchers Development & reinforcement of a scientific community at the European level Research projects and studies Dissemination of expertise to decision makers

16. Next steps:Eurorec level  Consideration and prioritization of social aspects  Participation to research projects e.g. EHR-IMPLEMENT  Establishment of a working group associating technical and social researchers

17. Conclusions  A real need exists for studying social, political and organisational aspects  This need should not be underestimated in National EHR implementation strategies  A lot can be learnt from social sciences “Adopting an innovation means adapting it” Michel Callon

18. Thank you “No success, no social acceptability without participation, without representation of actors, of innovators, of producers, of intermediaries, of political authorities and of end users” Michel Callon