ArticleJournal of the American Medical Informatics Association : JAMIA2025
Policy context and digital development: a comparative study of trajectories in 4 Canadian academic health centers over 30 years.
Article in Journal of the American Medical Informatics Association : JAMIA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- People and organizations: the human side of biomedical and health informatics.Journal of the American Medical Informatics Association : JAMIA · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
Abstract
objectivesThe digitalization of health records stands to improve decision-making at clinical, administrative, and policy level. Efforts follow various paths and are closely intertwined with health system and organizational configurations. Problems persist in both uptake and use. This study explores the digitalization trajectories of academic health centers (AHCs) to understand tensions between organizational and government strategies and their impact on digital development. MATERIALS AND
methodsAHCs play a leadership role within health systems in data-driven improvement. This retrospective case study draws on documentary, observational, and interview data to compare digitalization efforts over 3 decades in 4 AHCs in the province of Quebec (Canada).
resultsAt system level, strategy shifted from supporting multilayered development that encouraged bottom-up initiatives in the first decade of the 2000s, to harmonizing clinical information systems in a highly prescriptive manner after 2010. AHCs experienced the shift differently according to concurrent impacts of health system restructuring, and internal choices around electronic health record (EHR) systems and implementation priorities. Digital maturity remained low in all 4 AHCs. DISCUSSION: Coordination between system strategies and organizational strategies in AHCs was neglected in early digital development in Québec and improved only after an intense period of prescription and resistance. Confrontation highlighted tensions around different objectives at AHC and system level, competing missions within AHCs, and trade-offs between relying on commercial EHRs and developing publicly owned systems, all of which ultimately influence EHR implementation.
conclusionThe different experiences of focal organizations with digitalization underline the importance of adapting national strategies and providing support to implementers, building on acquired strengths, and arriving at the right balance of guidance from the top and autonomy to develop innovative capacities.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.