Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Mark Schlesinger

Abstract

This thesis explores how the United States can implement a national electronic health record (EHR) system by drawing lessons from three comparison countries (Germany, Italy, and Austria) that have implemented their own national EHRs. A national EHR, distinct from local electronic medical records (EMRs), is a centralized or linked platform that consolidates standardized patient health data across all care settings. While a national EHR offers significant benefits, such as improved patient safety, better clinical decision-making and care coordination, more efficient allocation of care, and expanded capacity for public health research, it also presents challenges related to data security, data quality and completeness, provider burden, and cost.To guide U.S. policy, countries that have implemented an EHR and are politically and economically similar to the U.S. were sought out. Countries belonging to the Organisation for Economic Co-operation and Development were ranked by similarity to the U.S. on healthcare system structure, decentralization of government, trust in government, and population size. After this process, Germany, Italy, and Austria were chosen as comparison countries for the highest similarity to the U.S. Using a qualitative analysis of each country's road to EHR implementation and the policy outcomes, a set of actionable recommendations tailored to the U.S. context was developed. These recommendations include using federal coordination with regional implementation, investing in interoperability infrastructure and standards, engaging physicians from the outset, integrating clinically meaningful data such as physician notes and patient summaries, planning for a long-term iterative rollout and addressing regional inequity, ensuring privacy protections alongside public education campaigns, and eventually transitioning from an opt-in to an opt-out system. Potential sources of opposition to implementing a national EHR in the U.S. include EMR vendors, independent physicians, and privacy advocates. Opposition can be managed through regulations, incentives, and campaigns to build trust. Ultimately, a national EHR in the U.S. is both achievable and important for improving healthcare quality and efficiency.

Comments

This is an Open Access Thesis.

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