Factors to consider when implementing patient online access to their electronic health record

Government and public agencies in Sweden have promoted the expansion of eHealth. The strategy behind this effort is to increase quality of care, efficiency, patient empowerment and patient safety, and one of the most important civic eHealth services is patient online access to electronic health records (EHR). By 2017, all of Sweden's inhabitants will be able to access their EHR from somatic care through the Internet and thus read clinical notes. In 2015 Region Skåne was the first county council in Sweden to implement patient online access to their EHR as a civic service, for adult psychiatric care patients. Earlier research shows that initial implementation of the service in somatic care raised both questions and resistance among involved healthcare professionals. Thus, for an implementer, there are many factors to consider and it may be difficult to choose and prioritize among them; on the other hand, there is little knowledge about what healthcare professionals think is important when implementing a civic service in healthcare. The aim of this study is to present and discuss what healthcare professionals think is important to consider when Region Skåne implements patient online access to EHR in psychiatric care. The material presented derives from a full-population web survey, distributed to employees in adult psychiatry in Region Skåne just before the introduction of the service. The response rate was 29% (n = 871). In one of the question in the survey, respondents were asked to choose five out of eleven factors that they thought might affect the implementation of the service. Thereafter they were asked to rank these five factors and assign the most important factor five points, the second most important factor four points and so on. Overall, the results show that the most frequently chosen factor was Evaluation of patient online access to their EHR, but Patient safety was the factor with the highest total score and also the highest mean value. Furthermore, it is interesting to note that the factor receiving the lowest score was a support line for the employees; this factor has the lowest total score and lowest mean value. The results also show that different professional groups consider different factors to be important in the implementation process. The conclusions are firstly; that healthcare professionals care about the implementation of civic services even though the technology does not change towards them. Secondly; that the healthcare professionals consider not only factors that affect their own work to be important but also factors that are related to patient's interests. Thirdly; it is important for implementers to be aware of that civic services can affect the healthcare professionals work even if the service is only aimed at patients. It is thus important to consider factors related to both patients and professionals when implementing a civic eHealth service, even if the service is aimed at only one of these groups