JMIR Publications

ABSTRACT

Background:

The integration of electronic health records (EHRs) in mobile care presents complex challenges in German-speaking countries (DACHL region: Germany, Austria, Switzerland, and Liechtenstein). While digitalization efforts are advancing, fragmented infrastructures, unclear access rights, and inconsistent implementation strategies hinder interdisciplinary data exchange, particularly in mobile nursing and care settings.

Objective:

This study aimed to explore expert perspectives on (1) the requirements and challenges for cross-sectoral integration of EHRs in mobile care within the DACHL region, (2) essential system functions and support structures, and (3) the expected impact of digital data exchange on care quality, workload, and collaboration.

Methods:

A modified Delphi approach was used, comprising two phases. In phase 1, qualitative expert interviews were conducted between January and April 2024 using a semi-structured interview guide. Interviews were analyzed using qualitative content analysis to derive key findings and thematic groups. These results informed the design of a structured online survey. In phase 2, two Delphi rounds were administered (round 1: April/May 2024; round 2: July/August 2024). The first round included 159 items rated on a 4-point Likert scale and a ranking task of EHR functions. In the second round, only items without prior consensus and the top-ranked functions were reassessed. Consensus was defined as ≥75% agreement or disagreement among participants.

Results:

Nineteen experts participated in qualitative interviews, 18 in the first survey round, and 15 in the second. Consensus was reached for 88.7% of the 159 items. Experts emphasized the importance of open, interoperable systems, standardized terminologies, and agile development tailored to mobile care. High agreement was found on the relevance of key EHR functions: diagnoses, medication lists, assessments, and medical history. Usability and differentiated support structures were considered essential for successful implementation. Cross-border data exchange, telemonitoring, and AI integration were seen as valuable, while the topic of access rights, particularly for assistant roles, provoked the most disagreement, indicating a need for further clarification in policy and practice.

Conclusions:

Experts in the DACHL region broadly agree on the functional and structural priorities for effective digital data exchange in mobile care. Interdisciplinary EHR implementation must prioritize interoperability, context-sensitive access policies, and usability. The findings provide a foundation for policy development, system design, and future research, contributing to safe and efficient digital care delivery across sectors and borders.