The creation and analysis of national databases from electronic health records to improve the safety and efficiency of health care requires strong governance of the national electronic health record system. Of the 25 countries participating in this part of the study, one-half have a national body that is responsible for EHR infrastructure development and for setting national standards for both the clinical terminology used within the records and the interoperability, or sharing, of records. Five countries have introduced or are planning to introduce legislation requiring health care providers to implement electronic health records that conform to national standards. Seven countries reported a certification process for software vendors to comply with national standards for clinical terminology and interoperability. Eleven countries report incentives or penalties to encourage health care providers to adopt electronic health record systems conforming to national standards; and to use their EHR system and keep records up-to-date. Six countries reported auditing EHR records for the quality of the clinical information. Seven countries reported engaging third parties to centralise one or more of the following tasks: building databases from electronic health records; de-identifying data to protect privacy; and granting access to data.This chapter explores results of the OECD study of 25 countries regarding the development of national bodies to oversee national EHR implementations; the use of legal requirements to adopt EHRs or adhere to standards; the use of incentives and penalties to encourage quality in the use of EHRs; concerns with data quality and the use of data quality auditing; and the engagement of third parties to assist with building databases, de-identifying data and approving applications for data access.