JMIR Publications

ABSTRACT

Background:

Patient portals are increasingly being implemented throughout the world to ensure patients with timely access to their health data, including 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.

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 specific usability problems that may need to be addressed in the future.

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 a free-text question regarding the usability of the system, and the responses to this question was analysed using content analysis with a socio-technical framework as guidance when grouping identified usability issues.

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). In total 186 respondents (7% of 2587) provided a free text comment to the usability questions. The analysis resulted in 19 categories, that could be grouped under 7 of the 8 dimensions in Sittig and Singhs socio-technical framework. The most frequently mentioned problems related to regional access limitations, structure and navigation of the patient portal, and language and understanding.

Conclusions:

Although the end-users of the PAEHR Journalen where overall satisfied with its usability, they also experienced important challenges when accessing their records. In order for all patients to be able to reap the benefits of record access, it is essential to both understand the usability challenges they encounter and more broadly how policies, regulations and technical implementation decisions impact the usefulness of record access. The results presented here are specific for the Swedish PAEHR Journalen, but also provide important insights on how design and implementation of record access can be improved in any context.