Abstract
BackgroundUppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment.ObjectiveThe study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment.MethodsA total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed.ResultsThe thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.ConclusionsSupported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment. Mostly, this is explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physicians’ ability to guide the patient. (2) The physicians’ experiences were expressed as worries: patients would not understand the content of the record and become unnecessarily anxious from misunderstandings. The concerns are to some extent based on a generalized view of patients, which might disregard those, who already actively participate in health care. This study hence reveals a need to provide physicians with information about the values for patients from using patient portals. (3) A change of work practices may be beneficial to increase patient participation, but such changes should preferably be designed and discussed with physicians. However, the strong resistance from the physicians made this challenging when launching the patient portal.
Highlights
Patient Portals and Aim of this PaperThe prospect of increasing costs in health care due to demographic changes and the increase of chronic diseases motivates politicians and policymakers to support patients to participate actively in their care
Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment
The analysis revealed 4 themes, which are: Work Tool, Process, Workload, and Control (Figure 1)
Summary
Patient Portals and Aim of this PaperThe prospect of increasing costs in health care due to demographic changes and the increase of chronic diseases motivates politicians and policymakers to support patients to participate actively in their care. The portal makes it possible for patients to log in on a Web service and read their health care information and test results and to use about 10 eHealth services These services include, for example, booking appointments, following referrals, and reading a list of names of all health care professionals who have entered the medical record (so-called “log list”). The patients could access their medical records either immediately after their physician had signed the note or if unsigned at the earliest after 14 days This way of showing the information with a delay from when it was originally written is called a “respite”. Most patients (98%) chose to see the unsigned records [8], which would be marked to distinguish them from the already signed notes
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