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The paper compares the politics of e‐health policy with a particular focus on the implementation of e‐health records (e‐HRs) in two SHI countries: Austria and Germany. Although these countries share many similarities in terms of political and health care regime, they differ widely with respect to health care digitalization. Thus, the question arises which configuration of factors has facilitated health system digitalization in Austria while being potentially absent in Germany. As a research strategy, we use the Advocacy Coalition Framework to identify the respective actor coalitions for and against the advancement of e‐HRs and analyze how their formation, their resources, and strategies are related to country‐specific governance structures. We find that differences in the beliefs of patient representatives; variations in the institutional access for physician associations; and, finally, differing internal dynamics within the pro e‐HRs main coalition do account for differences in health care digitalization. [ABSTRACT FROM AUTHOR]