Does anyone have any experience implementing an Electronic Medical Record at national level across multiple health care institutions ? What strategy did you adopt? How did you approach the requirement gathering, design, and implementation processes? What were the main challenges you experienced?

We have been building our own Hong Kong wide EMR system for 30 years now. Done properly, EMR is a transformative technology and a process of requirements gathering is likely to be ineffective - asking users what they need will get you conflicting, specialised, local requirements which will lead to digitisation of the past, not the future. By building our own system the system has advanced at the same pace (or just slightly ahead) of the healthcare enterprise as we have learnt together what the technology can do, so we have been able to effectively digital transform our healthcare at a fraction of the cost of a massive vendor implementation.

Bit of a sore point in the UK, but lessons learned from our decade-old, £10bn experiment on the  subject is at npfit-mpp-2014-case-history.pdf (cam.ac.uk). For all its faults (and the wasted £s), it has also done a lot of good in improving digital maturity across the healthcare system.

Implementing an Electronic Medical Record (EMR) system at a national level across multiple healthcare institutions is an extensive and complex undertaking that requires meticulous planning, collaboration, and phased execution. While I don't have direct experience with a national-level implementation, I can outline common strategies, approaches, challenges, and considerations based on best practices and known challenges in such implementations.

Strategy for Implementation:

1. Stakeholder Engagement: Engage stakeholders extensively, including healthcare providers, administrators, IT experts, and policymakers. Their involvement is crucial for understanding diverse requirements and ensuring buy-in.
2. Phased Rollout: Implement the system in phases or pilot programs across select institutions to test functionality, gather feedback, and refine the system before scaling it nationally.
3. Interoperability Standards: Ensure that the EMR system follows interoperability standards to allow seamless data exchange between different healthcare institutions and systems.
4. User Training and Support: Provide comprehensive training programs for healthcare professionals to ensure smooth adoption. Continuous support and troubleshooting mechanisms are essential.
5. Data Security and Privacy: Prioritize robust security measures and compliance with privacy regulations to safeguard patient data.

Requirement Gathering, Design, and Implementation:

1. Requirement Gathering: Conduct extensive consultations with healthcare professionals, administrators, and patients to understand their needs and workflows. This involves detailed documentation of requirements.
2. Design Phase: Create a comprehensive design that incorporates user-friendly interfaces, data entry methods, clinical decision support systems, and interoperability features.
3. Pilot Programs: Begin implementation in a few selected healthcare institutions to test the system's functionality, identify any gaps, and gather feedback for improvements.
4. Scalability and Customization: Ensure the system is scalable to accommodate the varying needs of different healthcare institutions while allowing for customization to align with specific workflows.
5. Change Management: Implement effective change management strategies to address resistance to change and ensure smooth adoption among healthcare professionals.

Main Challenges:

1. Interoperability Issues: Integrating EMR systems across diverse healthcare institutions with different legacy systems poses significant interoperability challenges.
2. Data Migration: Transferring large volumes of existing patient data accurately and securely from paper records or legacy systems to the new EMR system can be complex.
3. User Adoption: Resistance to change and a steep learning curve for healthcare professionals in adapting to new technologies can hinder adoption.
4. Cost and Resource Allocation: Implementing a national-level EMR system requires substantial financial investment and resources, posing challenges in budget allocation and resource management.
5. Regulatory Compliance: Ensuring compliance with various healthcare regulations and privacy laws across different regions or jurisdictions can be a significant challenge.

In essence, implementing an EMR system at a national level across multiple healthcare institutions is a monumental task. Best wishes. 

Could you expand on "implement", are you looking to integrate with EMR's or are you looking to build your own?

EMR integration should be facilitated by one of the well worn standards approaches if possible.  FHIR or X12 are often used in the integration and EDI world.

If you are contemplating building your own... good luck, I've seen numerous attempts, it's a very difficult area, do the wide use of the aforementioned EDI and integration paths.