JMIR Publications

ABSTRACT

Background:

Patients are increasingly being offered online record access (ORA) through Patient Accessible Electronic Health Records (PAEHR), yet implementation is often met with resistance from healthcare professionals (HCPs). Experiences from previous implementations may provide important insights into potential barriers and facilitators.

Objective:

To investigate factors influencing implementation of the Swedish PAEHR in primary care from HCPs’ perspective.

Methods:

We conducted 14 semi-structured interviews with a diverse group of HCPs shortly after the implementation of the Swedish PAEHR. The interviews were analysed using the Consolidated Framework for Implementation Research (CFIR) and content analysis, identifying key themes related to PAEHR implementation.

Results:

Several potential barriers and facilitators were identified. According to HCPs, the PAEHR had shortcomings but offered some flexibility. HCPs described working in a complex and challenging organisation, which nonetheless had an existing structure, support, and established communication with patients. They also described using EHR system for other purposes than documentation. Moreover, they reported dealing with a complicated patient group with varying needs and high expectations. HCPs expressed that they worked in a patient-centred way and with patient engagement. The HCPs could see both advantages and disadvantages with PAEHR and had some concerns. There were mixed views of the extent of the change, where some felt patient ORA would not affect their work at all and others expected a substantial impact. Some had experiences using PAEHR themselves, while some lacked knowledge or interest. Furthermore, the implementation process was perceived as long and uneventful, with fragmented communication, where existing communication activities were utilized. They also reported receiving some information and education about PAEHR outside the organisation. HCPs had limited awareness of how patients were introduced to the PAEHR.

Conclusions:

Shortcomings with the EHR system and within the organisation must be addressed for optimal implementation where patients’ and HCPs’ benefits and risks are mitigated. Moreover, improved information and education for patients and HCPs is a potential solution to address many concerns and perceived disadvantages of PAEHR.