Muli Irene, Cajander Åsa, Scandurra Isabella, Hägglund Maria
Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Information Technology, Uppsala University, Uppsala, Sweden.
JMIR Med Inform. 2025 Jun 6;13:e64982. doi: 10.2196/64982.
Patients are increasingly being offered online record access (ORA) through patient-accessible electronic health records (PAEHRs), but implementation is often met with resistance from health care professionals (HCPs). Experiences from previous implementations may provide important insights into potential barriers and facilitators.
This study aimed to investigate the factors influencing the implementation of the Swedish PAEHR system in primary care from the perspectives of HCPs.
We conducted 14 semistructured interviews with a diverse group of HCPs shortly after the implementation of the Swedish PAEHR system. The interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) and content analysis, identifying key themes related to PAEHR implementation.
The analysis identified several potential factors influencing the implementation of the Swedish PAEHR system. According to the HCPs, the PAEHR system was flawed but also flexible. The HCPs described working in a complex and imperfect organization, which nonetheless had an existing structure, support, and established communication with patients. They also described nondocumentation-related use of the electronic health record system. Moreover, they reported dealing with a complicated patient group with varying needs and high expectations. The HCPs expressed that they worked in a patient-centered way and with patient engagement. The HCPs could see both the advantages and disadvantages of the PAEHR system 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 HCPs had experience using the PAEHR system themselves, while some lacked knowledge and interest. Furthermore, the implementation process was perceived as long and uneventful, with fragmented communication, where existing communication activities were used. The HCPs also reported receiving some information and education about PAEHRs outside the organization. The HCPs had limited awareness of how patients were introduced to the PAEHR system.
This study underscores the importance of having a usable electronic health record system and addressing organizational issues, such as issues with the work environment, for optimal implementation of eHealth services such as the PAEHR system. It also highlights the importance of HCPs' views and experiences with their patients, and their perceptions and attitudes toward the intervention. Additionally, this study stresses the importance of effective implementation processes and communication strategies for both HCPs and patients.
通过患者可访问的电子健康记录（PAEHR），越来越多的患者能够获得在线记录访问（ORA），但实施过程往往遭到医疗保健专业人员（HCP）的抵制。以往实施过程中的经验可能为潜在的障碍和促进因素提供重要见解。
本研究旨在从HCP的角度调查影响瑞典初级保健中PAEHR系统实施的因素。
在瑞典PAEHR系统实施后不久，我们对不同类型的HCP进行了14次半结构化访谈。使用实施研究综合框架（CFIR）和内容分析法对访谈进行分析，确定与PAEHR实施相关的关键主题。
分析确定了几个影响瑞典PAEHR系统实施的潜在因素。据HCP称，PAEHR系统存在缺陷但也具有灵活性。HCP描述了在一个复杂且不完美的组织中工作，不过该组织有现有的结构、支持以及与患者已建立的沟通。他们还描述了电子健康记录系统与记录无关的用途。此外，他们报告称要应对需求各异且期望很高的复杂患者群体。HCP表示他们以患者为中心开展工作并让患者参与其中。HCP既能看到PAEHR系统的优点也能看到缺点，并且存在一些担忧。对于变革的程度存在不同看法，一些人认为患者ORA根本不会影响他们的工作，而另一些人预计会产生重大影响。一些HCP自己有使用PAEHR系统的经验，而一些人缺乏相关知识和兴趣。此外，实施过程被认为漫长且平淡无奇，沟通零散，只是利用了现有的沟通活动。HCP还报告称在组织外部获得了一些关于PAEHR的信息和教育。HCP对患者如何被引入PAEHR系统的了解有限。
本研究强调拥有一个可用的电子健康记录系统以及解决组织问题（如工作环境问题）对于PAEHR系统等电子健康服务的最佳实施的重要性。它还突出了HCP对患者的看法和经验以及他们对干预措施的认知和态度的重要性。此外，本研究强调了有效实施过程和沟通策略对HCP和患者的重要性。
