JMIR Publications

ABSTRACT

Background:

Transparency is increasingly called for in healthcare, not least when it comes to patients’ access to their electronic health records (EHR). In Sweden, the e-service Journalen is a national patient accessible EHR (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefit of using a PAEHR will influence behavioural intention to use and adoption, but poor usability that increases effort expectancy can have a negative impact. It is therefore of interest to further explore how users of the PAEHR Journalen perceive its usability and usefulness, the latter especially considering the differences in level of transparency implemented in different regions.

Objective:

The aim of this study is to explore how the users of the Swedish PAEHR experience the usability of the system, and to identify differences in this experience based on the level of transparency of the region.

Methods:

A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data was collected from June to October 2016. The questionnaire included questions regarding the usability of the system using the System Usability Scale (SUS). The SUS analysis is the focus of this paper. Analysis was performed on different levels; nationally looking at the whole data set, and breaking it down focusing on two different regions to explore differences in experienced usability based on the level of transparency.

Results:

During the survey period, 423 141 users logged into Journalen, of which 2587 completed the survey (unique users that logged in; response rate, 0.61%, 2587/423 141). The total score for all respondents to the SUS items was 81, which corresponds to system with good usability. To further explore whether the level of transparency in a region would affect the users experience of the usability of the system, we analysed the two regions with most respondents; Region Uppsala (first to launch, high level of transparency), and Region Skåne (early implementer, low level of transparency at the time of the survey). 692 respondents stated that they had received care in Region Skåne, whereas 520 respondents had received care in Region Uppsala. Both separate SUS analysis resulted in a final score of 81 (Uppsala 81.43 and Skåne 80.53).

Conclusions:

We conclude that the Swedish national PAEHR Journalen has a reasonably good usability (scoring 81 on SUS); however, further research into more specific usability areas are needed, to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared to low transparency region could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required.