From handwritten file cards to electronic health records: how widely accepted are electronic health records?

Why are many doctors and patients sceptical about systems such as ELGA (electronic health records), and which countries have succeeded in introducing effective systems? Anna Griesser recently completed her doctoral thesis at the University of Klagenfurt (Department of Business Management), in which she examined the factors that promote and inhibit the acceptance of electronic health records.

When was ELGA launched in Austria, and how was it initially received?

The system was introduced in 2015 based on the relevant legal framework. From the outset, large posters were displayed in many doctors’ offices warning patients against allowing their data to be stored in this system. The biggest concerns related to data protection and security. The rollout plan envisaged a much faster pace, but many aspects could only be implemented after significant delays. Today, some settings are still missing, such as outpatient care in hospitals and private doctors.

How many Austrians are registered with ELGA?

We have an opt-out system, which means that every individual is registered by default and must opt out of ELGA if they do not wish to participate. Currently, the annual opt-out rate in Austria is around three percent.

Are other approaches been taken elsewhere?

Yes, in France, the country I used in my comparison with Austria, there is an opt-in system. People who want to be included in the electronic health records must actively register to do so. We see that far fewer French people participate in this system. The example of Australia is interesting: Here, they switched from an opt-in to an opt-out approach. Using accompanying measures, they managed to get 90 percent of Australians to participate.

What were these accompanying measures?

Many patients are concerned that their data will be used improperly. In the Australian system, you remain in control of your own data because you can delete or ’hide’ individual areas. This has led to significantly greater acceptance.

You previously mentioned that many individuals in the healthcare profession, such as doctors and nurses, are sceptical. Why is that?

My research has shown that data protection concerns play an important role here. In addition, many doctors, especially the older generation, are reluctant to abandon their established file card system and introduce a new IT system in their practices. On top of that, there is also a certain fear that other colleagues might be watching over your shoulder and questioning your diagnoses and treatments if they can access them via ELGA.

Apart from data protection concerns, what are the main obstacles for patients?

General practitioners play an important role, as they are trusted confidants for many patients. If they support ELGA, this will have a positive effect; if they are reserved, this will have a negative impact on acceptance. Digital skills and how well the systems work also play a role. At the moment, there are a lot of issues with ID Austria, which is also putting people off.

Which system is more widely accepted – voluntary registration in France or automatic registration and deregistration in Austria?

Surprisingly, our studies show that there is no difference. Although one might expect scepticism to be greater with the opt-out model, as in Austria, our data does not confirm this. On the other hand, we do know from best practice examples in Australia that conscious efforts to strengthen security measures for data protection and privacy, along with a certain degree of flexibility within the system, have a positive effect on acceptance. The advantages must also be obvious in order to increase acceptance. However, this requires broad coverage across all settings so that patients benefit from no longer having to carry notes from A to B.