Accepted for/Published in: JMIR Human Factors
Date Submitted: Sep 10, 2023
Date Accepted: Feb 21, 2024
Acceptance ≠ Usage: what influences patients’ decisions to upload medical reports to the electronic health record (EHR)? A randomized controlled trial in Germany
ABSTRACT
Background:
The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German healthcare system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, three out of four Germans stated that they intend to use the EHR, but other studies show that intention to use a technology is not a reliable and sufficient predictor of actual use.
Objective:
Controlling for patients’ intention to use the EHR, we investigate whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain additional variance in patients’ decisions to upload medical reports to the EHR.
Methods:
In an online user study, each of N=241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs. low) and time course (acute vs. chronic) and to decide whether to upload it to the EHR.
Results:
Whereas disease-related stigma (OR 0.154; P<.001) offset the generally positive relationship between intention to use and the upload decision (OR 2.628; P<.001), time course showed no effect.
Conclusions:
Even if patients generally intend to use the EHR, risk perceptions, for example, related to diseases that are associated with social stigma, may deter people from uploading related medical reports to the EHR. To ensure reliable use of this key technology in digitalized healthcare system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR
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