Governance and Leadership in Electronic Health Record Implementation: A Knowledge Summary


Two focus areas in the National eHealth Strategy in Norway are "Governance and Management" and “Modernisation of Electronic Health Records (EHR)” (1). The variety of independent actors in the sector makes it necessary to strengthen the coordination of ICT development in a national governance model. In order to realize the objectives of the White Paper "One Citizen One Journal" (EIEJ), which is the foundation for the strategy, the government recommends that stakeholders from both state, municipality, citizens, and industry need to coordinate their decision-processes and actions. The adopted strategy is "Co-Governance"(2).

Co-governance is defined as: "... the non-hierarchical process whereby public and private actors and resources are coordinated and given common direction and meaning"(3). Governance models include all stakeholders and contain mechanisms for decisions and conflict resolution. The actors who participate, have different power bases and are co-dependent.

There are currently five ongoing EHR modernisation processes in Norway; one national covering primary healthcare, where procurement for municipalities and general practitioners is inititated. Additionally all four regional health authorities have initiated EHR implementation processes.

The Norwegian Directorate of E-health points out that there is a need for

"... systematic knowledge summaries in the e-health field". This poster presents preliminary results of a literature review on governance, leadership and management in e-health, and focuses specifically on EHR implementation. The purpose is to map different governance models and analyse the experiences.


  1. Conduct a systematic search within an already performed systematic review archived in the on-line tool Rayyan, undertaken in 2016 at the Norwegian Institute of Public Health following up a systematic review in 2009(4).
  2. Utilize results from an ongoing review at The Norwegian Centre for E-healthresearch (NSE) on Norwegian e-health actors and their topics.
  3. Conduct an additional search in Scopus and Web of Science combining search terms such as “co-governance”, “e-health” and “public governance”.
  4. Include articles on governance of EHR implementation processes.
  5. Data analysis will involve qualitative methods.


The search in Scopus and Web of Science was completed on the 25th of January 2018. The number of hits was 339. The selection process is ongoing.


The synthesis of the reviewed materials will be presented by a narrative description. The results will be classified in main conceptual categories that will be obtained during the results extraction.


We anticipate that the results will provide a broad overview of EHR implementation processes and governance models. The work will describe how models contribute to the realization of national e-health strategies and goals. Results will be disseminated through publications in a peer-reviewed journal and conferences as well as for domestic and international agencies in charge of e-health policy implementation.


  1. Direktoratet for e-helse. Nasjonal e-helsestrategi 2017-2022. In: Direktoratet for e-helse, editor. Oslo, Norway2017.
  2. Én innbygger - én journal : digitale tjenester i helse- og omsorgssektoren. Oslo: Departementenes servicesenter; 2012.
  3. Vabo SI. Governance på norsk. Samstyring som empirisk og analytisk fenomen. Norsk statsvitenskapelig tidsskrift. 2008;24(01-02):86-107.
  4. Ekeland AG, Bowes A, Flottorp S. Effectiveness of Telemedicine - a Systematic Review of Reviews. Int J Med Inform. 2010;79(11):736-71.