Growing cost of health care, the gradual reorganization of health care on a free-market basis and patients evolving into health care consumers all prompt hospitals to gain competitive advantage by improving efficiency, quality of care, and customer friendliness. An electronic health record system (EHR) is one of the tools to achieve these goals. Hospitals are nevertheless lagging behind industry in implementing IT systems to support their core business processes. Eighteen case studies were conducted among Dutch hospitals to examine the EHR system implementation. Through seventy three interviews with key stakeholders, the relation between perceived value of the EHR, the degree of participation in the implementation process, and the resulting quality of EHR systems was investigated. The value that end users expect is not achieved within Dutch hospitals. It was found that no hospital had so far reached third generation EHR functionality, even though several hospitals are actively pursuing it. Innovation with respect to EHR systems in hospitals is limited because of a lack of capabilities, not because of a lack of participation. Extensive and ill-targeted end user involvement tends to delay decision making and exacerbates the mismatch between implementation goals and results. Quality issues focus on information quality in terms of completeness and system quality in terms of reliability. This study contributes in combining participation models with the technology acceptance model and the IS success models. Electronic Health Records can be evaluated with this combination and a prescriptive analysis has lead to practical advice to the Dutch Ministry of Health.

For more than a decade, there have been claims of the advantages of Electronic Health Records (EHR). Nevertheless the results of these IT-based innovations do not meet the expected improvements in healthcare performance. This paper investigates this phenomenon by studying relevance and participation during the implementation process of EHR in four different hospitals. From the case studies it can be concluded that the relevance of EHR merely focuses on the availability of information at any time and any place. This employment of relevance does not meet end-users' expectations and is insufficient to accomplish the aspired improvements. The used participation approaches do not facilitate diffusion of EHR in hospitals. Participation from the start can help to leverage the relevance of the EHR, but the other way around more relevance can also help to motivate participation. A careful balance is needed to avoid a deadlock situation (No relevance, No participation).

Many information systems do not meet the expectations of the end-users. For electronic patient records (EPR) it is even worse, they are often not implemented yet. For more than a decade the society boasts the advantages of an EPR varying from millions of dollars to thousands of lives. Why do these IT based innovations not come to improvements of healthcare performance? This paper explores the transitions in the life cycle of an EPR from healthcare domain to information domain and back again. Both transitions have a large impact on the EPR success.