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Features and Frequency of Use of Electronic Health Records in Primary Care Across 20 Countries: A Cross-Sectional Study

22 Pages Posted: 5 Feb 2024

See all articles by Gabriele K. Kerr

Gabriele K. Kerr

Imperial College London - Department of Primary Care and Public Health

Niharika Kulshreshtha

Imperial College London - Department of Primary Care and Public Health

Geva Greenfield

Imperial College London - Department of Primary Care and Public Health

Edmond Li

Imperial College London - Institute of Global Health Innovation

Thomas Beaney

Leiro Health Center

Benedict WJ Hayhoe

Imperial College London - Department of Primary Care and Public Health

Josip Car

Imperial College London - Department of Primary Care and Public Health

Ana Clavería

Galicia Sur Health Research Institute

Claire Collins

Irish College of General Practitioners

Sandra Milena Espitia

Colombian Society of Family Medicine

Maria Jose Fernandez

Galicia Sur Health Research Institute

Gustavo Gusso

University of São Paulo (USP) - Department of Internal Medicine

Kyle Hoedebecke

Oscar Health - Department of Utilization Management

Robert D. Hoffman

Tel Aviv University

Greg Irving

Edge Hill University - Health Research Institute

Geronimo Jimenez

Leiden University - Department of Public Health and Primary Care

Liliana Laranjo

The University of Sydney

Vanja Lazić

Health Center Zagreb

Heidrun Lingner

Hannover Medical School

Ensieh Memarian

Lund University - Department of Clinical Sciences

Katarzyna Nessler

Jagiellonian University Medical College - Department of Family Medicine

Braden Gregory O'Neill

St. Michael's Hospital - MAP Centre for Urban Health Solutions

Davorina Petek

University of Ljubljana

Alice Serafini

Local Health Authority of Modena

Mehmet Ungan

Ankara University - Department of Family Medicine

Azeem Majeed

Imperial College London - Department of Primary Care and Public Health

Ana Luisa Neves

Imperial College London - Imperial NIHR Patient Safety Translational Research Centre

More...

Abstract

Background: Variation exists in the capabilities of Electronic Healthcare Records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability.

Methods: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer’s V.

Findings: Responses from 1,520 out of 1,605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 hours per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for “interactive patient education” (37·3%) or “home monitoring and self-testing of chronic conditions” (34·3%). Country of practice was associated with availability of all EHRs features (Cramer’s V range: 0·2–0·6), particularly with availability of tools enabling patient EHRs access (Cramer’s V: 0·6, p<0.0001). Greater feature availability of EHRs features was observed with greater digital maturity.

Interpretation: EHRs features intended for patient were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.Funding: UK National Institute of Health and Care Research.

Funding: This work is independent research supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Northwest London. ALN is also funded by the NIHR Patient Safety Research Collaborative, with infrastructure support from Imperial NIHR Biomedical Research Centre.

Declaration of Interest: BH also works for eConsult Health Ltd, provider of a platform for online consultations for NHS primary, secondary and urgent / emergency care.

Ethical Approval: Ethical approval was granted by the Imperial College Research Ethics Committee (Reference 20IC5956), which oversees health-related research with human participants. Survey participants gave their written informed consent to participate in the study.

Keywords: digital health, primary care, electornic health records, quality of care, virtual care, EHRs, telemedicine

Suggested Citation

Kerr, Gabriele K. and Kulshreshtha, Niharika and Greenfield, Geva and Li, Edmond and Beaney, Thomas and Hayhoe, Benedict WJ and Car, Josip and Clavería, Ana and Collins, Claire and Espitia, Sandra Milena and Fernandez, Maria Jose and Gusso, Gustavo and Hoedebecke, Kyle and Hoffman, Robert D. and Irving, Greg and Jimenez, Geronimo and Laranjo, Liliana and Lazić, Vanja and Lingner, Heidrun and Memarian, Ensieh and Nessler, Katarzyna and O'Neill, Braden Gregory and Petek, Davorina and Serafini, Alice and Ungan, Mehmet and Majeed, Azeem and Neves, Ana Luisa, Features and Frequency of Use of Electronic Health Records in Primary Care Across 20 Countries: A Cross-Sectional Study. Available at SSRN: https://ssrn.com/abstract=4711614 or http://dx.doi.org/10.2139/ssrn.4711614

Gabriele K. Kerr (Contact Author)

Imperial College London - Department of Primary Care and Public Health ( email )

Niharika Kulshreshtha

Imperial College London - Department of Primary Care and Public Health ( email )

Geva Greenfield

Imperial College London - Department of Primary Care and Public Health ( email )

Edmond Li

Imperial College London - Institute of Global Health Innovation ( email )

Thomas Beaney

Leiro Health Center ( email )

Benedict WJ Hayhoe

Imperial College London - Department of Primary Care and Public Health ( email )

Josip Car

Imperial College London - Department of Primary Care and Public Health ( email )

Ana Clavería

Galicia Sur Health Research Institute ( email )

Spain

Claire Collins

Irish College of General Practitioners ( email )

Dublin
Ireland

Sandra Milena Espitia

Colombian Society of Family Medicine ( email )

Maria Jose Fernandez

Galicia Sur Health Research Institute ( email )

Spain

Gustavo Gusso

University of São Paulo (USP) - Department of Internal Medicine ( email )

Kyle Hoedebecke

Oscar Health - Department of Utilization Management ( email )

Robert D. Hoffman

Tel Aviv University ( email )

Ramat Aviv
Tel-Aviv, 6997801
Israel

Greg Irving

Edge Hill University - Health Research Institute ( email )

Geronimo Jimenez

Leiden University - Department of Public Health and Primary Care ( email )

Liliana Laranjo

The University of Sydney ( email )

University of Sydney
Sydney, 2006
Australia

Vanja Lazić

Health Center Zagreb ( email )

Heidrun Lingner

Hannover Medical School ( email )

Carl-Neuberg-Str. 1
Hannover, 30625
Germany

Ensieh Memarian

Lund University - Department of Clinical Sciences ( email )

Katarzyna Nessler

Jagiellonian University Medical College - Department of Family Medicine ( email )

Braden Gregory O'Neill

St. Michael's Hospital - MAP Centre for Urban Health Solutions ( email )

Davorina Petek

University of Ljubljana ( email )

Dunajska 104
Ljubljana, 1000
Slovenia

Alice Serafini

Local Health Authority of Modena ( email )

Mehmet Ungan

Ankara University - Department of Family Medicine ( email )

Azeem Majeed

Imperial College London - Department of Primary Care and Public Health ( email )

Ana Luisa Neves

Imperial College London - Imperial NIHR Patient Safety Translational Research Centre ( email )

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