Sociotechnical Cross-Country Analysis of Contextual Factors That Impact Patients'Access to Electronic Health Records in 4 European Countries:Framework Evaluation Study

Background: The NORDeHEALTH project studies patient-accessible electronic health records (PAEHRs) in Estonia, Finland,Norway, and Sweden. Such country comparisons require an analysis of the sociotechnical context of these services. Althoughsociotechnical analyses of PAEHR services have been carried out in the past, a framework specifically tailored to in-depthcross-country analysis has not been developed. Objective: This study aims to develop and evaluate a method for a sociotechnical analysis of PAEHRs that advances a frameworkfor sociotechnical analysis of eHealth solutions first presented by Sittig and Singh. This first article in a series presents thedevelopment of the method and a cross-country comparison of the contextual factors that enable PAEHR access and use. Methods: The dimensions of the framework for sociotechnical analysis were thoroughly discussed and extended in a series ofworkshops with international stakeholders, all being eHealth researchers focusing on PAEHRs. All countries were representedin the working group to make sure that important national perspectives were covered. A spreadsheet with relevant questionsrelated to the studied services and the various dimensions of the sociotechnical framework was constructed and distributed to the4 participating countries, and the project participants researched various national sources to provide the relevant data for thecomparisons in the 10 sociotechnical dimensions. Results: In total, 3 dimensions were added to the methodology of Sittig and Singh to separate clinical content from featuresand functions of PAEHRs and demonstrate basic characteristics of the different countries regarding national and regional steeringof health care and information and communications technology developments. The final framework contained the following dimensions: metadata; hardware and software computing infrastructure; features and functions; clinical content shared withpatients; human-computer interface; people; workflow and communication; the health care organization's internal policies,procedures, and culture; national rules, regulations, and incentives; system measurement and monitoring; and health care systemcontext. The dimensions added during the study mostly concerned background information needed for cross-country comparisonsin particular. Several similarities were identified among the compared countries, especially regarding hardware and softwarecomputing infrastructure. All countries had, for example, one national access point, and patients are provided a PAEHRautomatically. Most of the differences could be identified in the health care system contextdimension. One important differenceconcerned the governing of information and communications technology development, where different levels (state, region, andmunicipality) were responsible in different countries. Conclusions: This is the first large-scale international sociotechnical analysis of services for patients to access their electronichealth records; this study compared services in Estonia, Finland, Norway, and Sweden. A methodology for such an analysis wasdeveloped and is presented to enable comparison studies in other national contexts to enable future implementations and evaluationsof PAEHRs.