How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France.

BACKGROUND: Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria. METHODS: A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021. RESULTS: Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR. CONCLUSION: Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term. PRACTICAL IMPLICATIONS: Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.

A holistic view of facilitators and barriers of electronic health records usage from different perspectives: A qualitative content analysis approach.

BACKGROUND: Electronic health records (EHR) are seen as a promising endeavour, in spite of policies, designs, user rights and types of health data varying across countries. In many European countries, including Austria, EHR usage has fallen short when compared to the deployment plans. OBJECTIVE: By adopting a qualitative approach, this research aimed to explore facilitators and barriers experienced by patients and physicians across the entire EHR usage process in Austria. METHOD: Two studies were conducted: In Study 1, discussions were held with four homogeneously composed groups of patients (N = 30). In Study 2, eight expert semi-structured interviews were conducted with physicians to gain insights into potential facilitators and barriers Austrian physicians face when utilising personal EHR. RESULTS: A wide range of barriers and facilitators were identified along the entire EHR usage spectrum, emerging on three different levels: the micro-level (individual level), the meso-level (level of the EHR system) and the macro-level (level of the health system). EHR literacy was identified as a booster to support EHR adherence. Health providers were identified as crucial gatekeepers with regard to EHR usage. CONCLUSION: The implications for mutual benefits arising out of EHR usage among the triad of health policymakers, providers and patients for both theory and practice are discussed.

A Process Related View on the Usage of Electronic Health Records from the Patients' Perspective: A Systematic Review.

BACKGROUND: In recent years, there has been an increasing interest in electronic health record (EHR) systems and various approaches of encouraging acceptance. Multiple methods of EHR acceptance have been proposed. However, a systematic review of patient's perspectives of their role and challenges in processing EHR remains lacking. Moreover, so far, there has been little discussion about barriers and facilitators of EHR system acceptance and usage from the patients' perspective. METHODS: The study was reported according to the PRISMA statement. Six databases were systematically searched using keywords for articles from 2002-2020. We reviewed these data and used an inductive approach to analyse findings. RESULTS: A total of 36 studies met the inclusion criteria. Our systematic literature review results reveal a wide range of barriers and facilitators assigned to four distinct stages of EHR system usage: awareness, adoption, behaviour and perception, and consequences. Results were described in a narrative synthesis of the included empirical studies. DISCUSSION: Results underline the necessity to put a particular emphasis - but not exclusively - on the initial stage of awareness in the future. Further research in the field is therefore strongly recommended in order to develop tailored mediated communication to foster EHR system usage in the long run.

[Subjective theories on quality of life and health in old age : An explorative study with nursing home residents and their nursing personnel]. / Subjektive Theorien zu Lebensqualität und Gesundheit im Alter : Eine explorative Studie mit Pflegeheimbewohnern und ihren Pflegekräften.

BACKGROUND: The terms "quality of life" and "health" are often used interchangeably even though there are indications to suggest that they are distinct constructs. Nevertheless, studies which would help to understand the difference between these constructs on the level of subjective theories of nursing home residents are lacking. Because nursing personnel can essentially contribute to the quality of life of residents, the comparison of subjective theories from residents and from nursing personnel can help to detect and understand potential discrepancies. MATERIAL AND METHODS: Semi-structured interviews were conducted with 31 pairs of residents and their nursing personnel. Based on the approach of Fliege and Filipp (2000) one half of the respondents answered the questions using the term "quality of life" and the other half using the term "health". In addition, quality of life and health had to be rated on a visual analogue scale (VAS), whereby residents rated themselves and nurses rated the corresponding resident. Data were analyzed using qualitative content analysis in a team-based approach. Following a mixed methods approach the deductively developed main categories and the inductively developed subcategories were quantified and statistically analyzed together with the VAS ratings. RESULTS AND CONCLUSION: Quality of life was more strongly associated with psychological, social and environmental aspects, whereas health more strongly evoked thoughts on physical functioning. This effect was stronger in nursing personnel, which can be explained by their role concept. In future scientific studies the terms should be used accurately, as they elicit different associations. The term "quality of life" seems to be more suitable to adequately reflect the adaptability of elderly people.