Department of Marketing and International Management, University of Klagenfurt, Klagenfurt Am Woerthersee, Austria.
ICD Business School - LARA, Management Department, Lara, France.
BMC Health Serv Res. 2024 Apr 8;24(1):439. doi: 10.1186/s12913-024-10929-w.
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.
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.
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.
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.
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.
电子健康记录（EHR）正在成为许多发达国家医疗体系的一个组成部分，尽管实施和设置因国家而异。一些国家采取了“选择退出”政策，即默认情况下将患者纳入 EHR 系统，而另一些国家则采用了“选择加入”政策，即患者必须采取行动选择加入系统。虽然“选择加入”系统可能表现出较低水平的主动用户访问请求，但与“选择退出”系统形成对比的是，“选择退出”系统中有相当比例的用户可能被动保留访问权限。因此，我们的研究旨在探讨在法国和奥地利这两个采用“选择加入”或“选择退出”设置的国家中，促进和阻碍 EHR 使用（即主动访问 EHR 系统）的因素。
在这两个国家采用了定性探索性方法，使用半结构化访谈指南：1）在奥地利，进行了四次同质组成的小组讨论；2）在法国，进行了 19 次单人患者访谈。数据于 2020 年 10 月至 2021 年 1 月收集。
影响因素被分为十二个亚类。在所有促进类别的方面，两国的患者都有类似的经历，例如，医疗保健提供者的角色、对 EHR 的认识和社会规范。然而，我们强调了两个系统之间在阻碍 EHR 使用的障碍方面的重要差异，例如缺乏关于 EHR 的沟通、透明度或信息安全。
实施额外的保障措施来增强隐私保护，并支持患者提高其数字能力，可能有助于减少对 EHR 带来的障碍的感知，并从长远来看提高患者的健康和投入度。
了解差异和相似之处将有助于制定切实可行的措施，从长远来看解决 EHR 使用率低的问题。这个问题在采用这两种类型的 EHR 默认设置的国家都普遍存在。
