Towards an Adoption Framework for Patient Access to Electronic Health Records: Systematic Literature Mapping Study

Abstract

Background Patient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. However, the adoption of patient portals and personal health records (PHRs) that facilitate this access is impeded by barriers. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user. Objective We aim to extend the scope of the CAF to patient access to EHRs, develop guidance documentation for the application of the CAF, and assess the interrater reliability. Methods We systematically reviewed existing systematic reviews on patients' access to EHRs and PHRs. Results of each review were mapped to one of the 43 CAF categories. Categories were iteratively adapted when needed. We measured the interrater reliability with Cohen’s unweighted kappa and statistics regarding the agreement among reviewers on mapping quotes of the reviews to different CAF categories. Results We further defined the framework’s inclusion and exclusion criteria for 33 of the 43 CAF categories and achieved a moderate agreement among the raters, which varied between categories. Conclusions In the reviews, categories about people, organization, system quality, system use, and the net benefits of system use were addressed more often than those about international and regional information and communication technology infrastructures, standards, politics, incentive programs, and social trends. Categories that were addressed less might have been underdefined in this study. The guidance documentation we developed can be applied to systematic literature reviews and implementation studies, patient and informal caregiver access to EHRs, and the adoption of PHRs.

The Role of Formative Evaluation in Promoting Digitally-based Health Equity and Reducing Bias for Resilient Health Systems: The Case of Patient Portals

“…Where work explores social contexts, these tend to focus on individual behavioural dimensions of use, usability of the technology, and organisational components surrounding adoption (e.g., perceived facilitators and barriers). Other factors, such as existing information infrastructures, regulations, political strategies and wider societal contexts are often neglected [45,46]. In addition, too often those with particular circumstances are considered "hard to reach" or "disadvantaged" -terms labelling a user group negatively as an outlier.…”

Comparative study of different SES neighborhood clinics for health literacy and internet access

“…[1][2][3] This past year of COVID-19 has clearly demonstrated the value and need for technology such as telemedicine [4][5][6][7] and patient portals for electronic health records. [8][9][10][11][12] However, technology is becoming critical for healthcare beyond the challenges imposed by the pandemic. For example, the increasingly important role of screening and testing for genetic conditions as part of precision medicine relies heavily on the use of computer-based technology.…”