Why e-government projects fail: main antecedents of the non-adoption of electronic health records in Germany according to stakeholder perceptions

Abstract

The Electronic Health Record in Germany was introduced in January 2021 and offers the integrated use of the application across sectors and institutions. However, two years after this introduction, less than 1% of the German population has applied for such a record with their health insurance provider. This is despite evident support of medical professionals as well as the society at large. To explain this non-adoption in particular and e-government non-adoption in general, the main goal of this thesis is the synthesis of the main antecedents of e-government non-adoption by investigating the perceptions of its main stakeholders: political stakeholders, medical professionals and citizens. Building on the assumption that non-adoption is not simply the opposite of adoption, and that perceptions of stakeholders play a crucial role in the engagement with e-government, this study is set in an interpretive, single case study. Moreover, the research conducted in this thesis employs Q-methodology, a mixed-methods approach that allows for the study of subjective experiences, and therefore perceptions. Analyzing the data from 29 participants (4 political stakeholders, 9 medical professionals and 16 citizens), this study found four main antecedents of non-adoption: communication, trust, design and attitude. These can be considered a starting point for more research focused explicitly on non-adoption and give valuable insights for practitioners.