Abstract
BackgroundPatient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. However, the adoption of patient portals and personal health records (PHRs) that facilitate this access is impeded by barriers. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user.ObjectiveWe aim to extend the scope of the CAF to patient access to EHRs, develop guidance documentation for the application of the CAF, and assess the interrater reliability.MethodsWe systematically reviewed existing systematic reviews on patients' access to EHRs and PHRs. Results of each review were mapped to one of the 43 CAF categories. Categories were iteratively adapted when needed. We measured the interrater reliability with Cohen’s unweighted kappa and statistics regarding the agreement among reviewers on mapping quotes of the reviews to different CAF categories.ResultsWe further defined the framework’s inclusion and exclusion criteria for 33 of the 43 CAF categories and achieved a moderate agreement among the raters, which varied between categories.ConclusionsIn the reviews, categories about people, organization, system quality, system use, and the net benefits of system use were addressed more often than those about international and regional information and communication technology infrastructures, standards, politics, incentive programs, and social trends. Categories that were addressed less might have been underdefined in this study. The guidance documentation we developed can be applied to systematic literature reviews and implementation studies, patient and informal caregiver access to EHRs, and the adoption of PHRs.
Highlights
Patient access to electronic health records (EHRs) is becoming increasingly common and is even a legal right in many countries
We showed how the Clinical Adoption Framework (CAF) can be applied to studies evaluating patient access to EHRs and personal health record (PHR)
The variability in the application of the CAF categories found in previous studies [15,16,17,18] can be explained by ambiguities that were addressed by the inclusion and exclusion criteria of this study
Summary
Patient access to electronic health records (EHRs) is becoming increasingly common and is even a legal right in many countries. EHRs have been associated with increased patient engagement and improved health care quality outcomes [1,2,3,4,5,6,7,8]. There are barriers to patients’ access to EHRs. For example, some patients have difficulties logging in to patient portals and personal health records (PHRs), which facilitate access, due to complicated security procedures [1,2,3,4,5,6,7,8]. A framework is needed to assess the determinants and outcomes of PHR and EHR adoption that facilitates this access. Patient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user
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