Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study

G Kerr; N Kulshreshtha; G Greenfield; E Li; T Beaney; B W J Hayhoe; J Car; A Clavería; C Collins; S M Espitia; M J Fernandez; G Gusso; K Hoedebecke; R D Hoffman; G Irving; G Jimenez; L Laranjo; V Lazić; H Lingner; E Memarian; K Nessler; B G O'Neill; D Petek; A Serafini; M Ungan; A Majeed; A L Neves

doi:10.1016/j.puhe.2024.05.001

Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study

Public Health. 2024 Aug:233:45-53. doi: 10.1016/j.puhe.2024.05.001. Epub 2024 Jun 6.

Authors

G Kerr¹, N Kulshreshtha², G Greenfield³, E Li⁴, T Beaney⁵, B W J Hayhoe³, J Car⁶, A Clavería⁷, C Collins⁸, S M Espitia⁹, M J Fernandez¹⁰, G Gusso¹¹, K Hoedebecke¹², R D Hoffman¹³, G Irving¹⁴, G Jimenez¹⁵, L Laranjo¹⁶, V Lazić¹⁷, H Lingner¹⁸, E Memarian¹⁹, K Nessler²⁰, B G O'Neill²¹, D Petek²², A Serafini²³, M Ungan²⁴, A Majeed³, A L Neves³

Affiliations

¹ Department of Primary Care and Public Health, Imperial College London, London, UK; NIHR Applied Research Collaboration Northwest London, London, UK. Electronic address: [email protected].
² Department of Primary Care and Public Health, Imperial College London, London, UK.
³ Department of Primary Care and Public Health, Imperial College London, London, UK; NIHR Applied Research Collaboration Northwest London, London, UK.
⁴ Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
⁵ Leiro Health Center, Leiro, Spain.
⁶ Department of Primary Care and Public Health, Imperial College London, London, UK; School of Life Course and Population Sciences, King's College London, London, UK.
⁷ Primary Care Research Unit, Vigo Health Area, Vigo, Spain; Galicia South Health Research Institute, Vigo, Spain.
⁸ Irish College of General Practitioners, Dublin, Ireland; Deptartment of Public Health and Primary Care, Ghent University, Belgium.
⁹ Colombian Society of Family Medicine, Bogotá, Colombia.
¹⁰ Galicia South Health Research Institute, Vigo, Spain; Leiro Health Center, Leiro, Spain.
¹¹ Department of Internal Medicine, Universidade de São Paulo (USP), Brazil.
¹² Department of Utilization Management, Oscar Health, Dallas, TX, United States.
¹³ Department of Family Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel.
¹⁴ Health Research Institute, Edge Hill University, Ormskirk, United Kingdom.
¹⁵ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
¹⁶ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁷ Health Center Zagreb, Zagreb, Croatia.
¹⁸ Center for Public Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Hannover Medical School, Hannover, Germany.
¹⁹ Department of Clinical Sciences, Internal Medicine Research Group, Lund University, Malmö, Sweden.
²⁰ Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland.
²¹ MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
²² Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
²³ Local Health Authority of Modena, Modena, Italy.
²⁴ Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkiye.

PMID: 38848619
DOI: 10.1016/j.puhe.2024.05.001

Abstract

Objectives: 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.

Study design: Cross-sectional study.

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.

Results: Responses from 1520 out of 1605 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 h 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.

Conclusions: EHRs features intended for patient use 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.

Keywords: Digital Health; EHRs; Electornic health records; Primary Care; Quality of care; Telemedicine; Virtual Care.

MeSH terms

Adult
Cross-Sectional Studies
Electronic Health Records* / statistics & numerical data
Female
Humans
Male
Middle Aged
Physicians, Primary Care / statistics & numerical data
Primary Health Care* / statistics & numerical data
Surveys and Questionnaires