Internationally, the last decade has seen the rapid adoption of electronic health records (EHRs) in hospitals and ambulatory care; EHRs are now an accepted enabler of a high-performing health system. However, the uptake and extent of use of this technology varies substantially. At the country level, Estonia and Sweden are among those nations with mature, interoperable EHRs with high patient access. In contrast, Switzerland and the UK have only patchy adoption in secondary care, and New Zealand, an early exemplar of primary care digitisation, http://dx.doi.org/10.1136/bmjqs-2019-010002has not yet integrated this information nationally, nor that of hospitals, at scale. Within countries also, there is variation. Even in jurisdictions with high overall rates of adoption, some providers are sophisticated ‘super-users’ of EHRs, whereas others use only their rudimentary functionalities.