Understanding patients' facilitators and barriers of the entire EHR u...

The process of digitalization in health has led to new approaches for patient care and networking with and between health professionals and is accelerated by, e.g., challenges with regard to long-time care, demographic change, or multimorbidity. These challenges have dramatically changed the situation for health actors. This phenomenon captures more and more spheres of health care (e.g., online follow-up examinations, electronic prescription/medication plans, or wearable technology applications for support in chronic disease care). A promising endeavor at the early stages of digitalization was the connection of patient-related electronic health records (EHR) between health care providers during a treatment process. Grounded in patient individualization and shared-decision making, EHR guarantees transparent access and an interoperability network for the treatment process also from a longitudinal perspective.

Nevertheless, regardless of optimized health and digital opportunities, many patients lack acceptance of electronic health records, resulting in information asymmetries, and a 'best-point-of-service' is still far off. A holistic view of the entire process of EHR usage, initially beginning by awareness, proceeding to adaption, usage, and the final performance, however, has been lacking. Thus, the current approach aims to reduce knowledge gaps regarding the barriers and facilitators of patients' and health professionals' EHR usage in each phase.

A qualitative approach using focus group discussions and expert interviews is utilised to explore the facilitators and barriers of the entire EHR usage process, including awareness-raising, adaption configuration, actual usage, and final performance. In a first step, we have conducted four focus groups, outlined with an interview guideline, with patients to examine influencing aspects to the entire EHR usage process. The groups were divided into homogenous subgroups according to age and EHR usage experience. One group was composed of younger people (up to 45 years) with user experience and one without user experience. Another group was composed of older people (46 years and more) with user experience and one without user experience. This approach resulted in four groups with 28 interviewees in total. All of the interviews were transcribed in full verbatim and analysed using qualitative content analysis (Mayring, 2014). The main deductive categories that occurred as facilitators or barriers for multiple steps in EHR usage were current awareness, the existing experience of use, the willingness to use, and ideal conception. Other inductive categories were drawn out of the material.

Furthermore, the present study also aims to analyse transparent barriers and facilitators of EHR usage from the perspective of health professionals. We plan to conduct eight to twelve semi-structured interviews with experts from healthcare organizations (physicians). Also, the expert interviews will be transcribed in full verbatim and analysed using qualitative content analysis (Mayring, 2014). A targeted communication policy from a health-communication perspective might have to be set, highlighting needs and potential benefits in the long run.