Health Care Professionals’ Perspectives on Implementing Patient-Accessible Electronic Health Records in Primary Care: Qualitative Study
Bibliographic record
Abstract
BACKGROUND: 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. OBJECTIVE: This study aimed to investigate the factors influencing the implementation of the Swedish PAEHR system in primary care from the perspectives of HCPs. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.011 | 0.008 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".