Flexibility in EHR ecosystems
five integration strategies and their trade-offs
In this paper, we address various strategies to integrate Electronic Health Record systems with other software features and information sources. We identify a critical tension between a) the end users’ desire for a seamless EHR workflow, and b) the system architects’ desire for a loose and modular integration, which favors change and evolution of various applications and components over time. Through a qualitative study from Norway, we examined the integration strategies of an EHR system with i) a specialized patient record solution for childbirth, ii) an ePrescription system, and iii) an integrated Summary Care Record system. We complement these empirical studies with related research concerning one additional EHR integration strategy identified in the health informatics literature. We illustrate how four of the strategies compromise either end-users' need for seamless workflow or system architects' desire for a changeable and loosely integrated portfolio of information systems. However, one particular strategy, albeit experimental, shows promise in resolving the identified tension to a more substantial degree than the other four.