Factors Influencing Development and Implementation of Patients' Access to Electronic Health Records-A Comparative Study of Sweden and the Netherlands.

Charlotte D Cijvat,Maria Hägglund,Ronald Cornet

doi:10.3389/fpubh.2021.621210

Abstract

Background: Patient-accessible electronic health records (PAEHRs) and associated national policies have increasingly been set up over the past two decades. Still little is known about the most effective strategy for developing and implementing PAEHRs. There are many stakeholders to take into account, and previous research focuses on the viewpoints of patients and healthcare professionals. Many known barriers and challenges could be solved by involving end-users in the development and implementation process. This study therefore compares barriers and facilitators for PAEHR development and implementation, both general and specific for patient involvement, that were present in Sweden and the Netherlands.Methods: There were a total of 14 semi-structured interviews with 16 key informants from both countries, on which content analysis was performed. The Consolidated Framework for Implementation Research was used to guide both the construction of the interview guides and the content analysis.Outcomes: The main barriers present in both countries are resistance from healthcare professionals and technical barriers regarding electronic health record systems and vendors. Facilitators varied across the two contexts, where the national infrastructure and program management were highlighted as facilitators in Sweden and stakeholder engagement (including patients and healthcare professionals) was described as a facilitator in both contexts. Strong leadership was also described as a critical success factor, especially when faced with healthcare professional resistance.Conclusion: Most of the major barriers and facilitators from both countries are covered in existing literature. This study, however, identified factors that can be seen as more practical and that would not have arisen from interviews with patients or physicians. Recommendations for policymakers include keeping the mentioned barriers in mind from the start of development and paving the way for facilitators, mainly strict policies, learning from peer implementers, and patient involvement, when possible. Implementers should focus on strong decision-making and project management and on preparing the healthcare organization for the PAEHR.

Highlights

Over the past two decades, advancements in law, technology, and policy have stimulated the implementation of patient-accessible electronic health records (PAEHRs) [1]
The results of our analysis are presented in two sections; 1. analysis of barriers and facilitators to implementation of PAEHRs, and
We have identified the main barriers and facilitators to developing and implementing national PAEHR policy as described by the respondents from both countries

Summary

Introduction

Over the past two decades, advancements in law, technology, and policy have stimulated the implementation of patient-accessible electronic health records (PAEHRs) [1]. These systems, set up by either healthcare providers or governments, allow patients to access their medical data whenever they want. Providing access to medical data potentially improves patient empowerment, leading to less consultations and more efficient healthcare provision, lowering healthcare expenditure and resulting in better health outcomes [4] Since these benefits can occur on an individual healthcare provider level and for the whole healthcare system, many countries take a national approach to either developing national PAEHRs or creating national policies for implementation [5]. This study compares barriers and facilitators for PAEHR development and implementation, both general and specific for patient involvement, that were present in Sweden and the Netherlands

Objectives

Methods

Results

Discussion

Conclusion