Electronic Health Records (EHR) systems have become a cornerstone of modern healthcare, aiming to improve patient management, streamline operations, and enhance data-driven decision-making. While much attention is often given to EHR adoption in the United States, countries worldwide are developing and implementing their own systems, tailored to local needs, policies, and healthcare structures. EHR systems outside the United States reveal diverse approaches, successes, and challenges, providing valuable insights into global health informatics.
EHR Systems in Europe
The healthcare systems with the greatest adoption of EHR systems are outside the US, with Nordic countries like Denmark, Sweden, and Finland boasting near-universal coverage and interoperability across healthcare providers. Centralized systems make it easy to share patient data between hospitals, clinics, and general practitioners, improving continuity of care. Denmark’s “Sundhed.dk,” a national health portal, allows patients to access their records, book appointments, and communicate with healthcare providers 1,2.
Despite successes in some places, many European countries face issues with fragmented systems. In Germany and France, a number of structural factors hinder the smooth national implementation of EHR systems. Privacy concerns under the General Data Protection Regulation (GDPR) add complexity to data management and cross-border healthcare initiatives 3–5.
EHR Systems in Asia
China has rapidly scaled its EHR systems, driven by its National Health Informatization Plan. Large hospitals in urban areas have sophisticated EHRs, enabling efficient management of millions of patient records. However, rural regions lag behind, with limited access to digital healthcare infrastructure. Interoperability remains a challenge in connecting diverse systems across the country 6–8.
India’s National Digital Health Mission (NDHM) aims to establish a unified digital health system, including an EHR system linked to unique health identifications. However, the initiative faces significant obstacles, including low healthcare digitization in rural areas and varying literacy levels, on top of general concerns about data security and privacy 9.
EHR Systems in Africa
Africa’s EHR landscape reflects the continent’s diverse healthcare needs and economic disparities—countries like South Africa and Kenya have adopted EHRs in urban hospitals, while many rural areas rely on paper-based systems or basic digital tools. The lack of infrastructure, unreliable internet access, and funding constraints pose significant challenges to more widespread adoption in many African countries.
Innovative approaches, such as cloud-based EHRs and mobile health solutions, are gaining ground. For example, Kenya’s open-source OpenMRS platform supports EHR implementation in resource-limited settings 10–12.
EHR Systems in Latin America
Latin American countries are largely seeing gradual adoption of national EHR systems, spurred by governmental efforts and private sector investment. Countries like Brazil and Chile have implemented national health information systems, but uneven adoption persists due to economic disparities and limited interoperability. A notable success story is Uruguay’s Historia Clínica Electrónica Nacional (HCEN), a nationwide EHR system connecting public and private providers—demonstrating how strong government leadership and a collaborative approach can overcome systemic barriers 13–15.
Global Challenges and Lessons
Both inside and outside the US, one of the most persistent challenges facing the use of EHR systems is achieving interoperability—ensuring that systems can communicate seamlessly across different platforms, facilities, and borders. In addition, data privacy and cybersecurity are universal concerns 16,17.
References
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13. Historia Clínica Electrónica Nacional | Agencia de Gobierno Electrónico y Sociedad de la Información y del Conocimiento. https://www.gub.uy/agencia-gobierno-electronico-sociedad-informacion-conocimiento/node/312.
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16. What is EHR Interoperability and why is it important? | HealthIT.gov. https://www.healthit.gov/faq/what-ehr-interoperability-and-why-it-important.
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