Adoption of Personal Health Records in Dutch Hospitals and Private Medical Clinics: Longitudinal Study

Personal health records (PHRs) allow patients to monitor, track, and manage their health, improve patient-provider communication, and enable the collection, management, and use of health data from various health care organizations. Despite their potential to empower patients and facilitate health care professionals' practices, PHR adoption remains challenging.

This study aims to examine longitudinal PHR adoption in Dutch general hospitals, academic hospitals, and private medical clinics.

We studied PHR adoption using the Technology Adoption and Readiness Scale (TARS) over time. TARS evaluates eHealth adoption, implementation, and embedment in organizations. It includes 7 subscales: coherence (sense-making and understanding of the new practice), cognitive participation (engagement with the new practice), contextual integration (integrating the new practice in the organization's overall goals and structure), skill set workability (integrating with existing working practices and skills), relational integration (the fit with existing professional relationships), interactional workability (whether the practice enables interactions), and reflexive monitoring (appraisal of the new practice). The TARS consists of 32 statements using a 6-point Likert scale ranging from completely disagree to completely agree. After each TARS statement, participants had the opportunity to explain their answer (optional open question). Contact persons per organization of a national program completed the questionnaire in the autumn of 2021 (n=143), 2022 (n=131), and 2023 (n=101). Mixed-model analysis using IBM SPSS was done for the quantitative data and content analysis was done for the qualitative data.

Significant improvements in coherence (P<.001), cognitive participation (P=.01), and skill set workability (P=.02) were observed over time. Conversely, interactional workability showed a significant decline (P=.01). No changes were observed for relational integration (P=.06) and reflexive monitoring (P=.77). The development of contextual integration differed over time between the different types of organizations (P<.001); in private medical clinics, contextual integration decreased, while it increased in both general and academic hospitals. General hospitals consistently scored lower on coherence, cognitive participation, and reflexive monitoring compared to private medical clinics. Qualitative analysis indicated that communication about PHRs improved sense-making and increased professional engagement and commitment. Barriers to adoption included technical issues, financial constraints, concerns about the digital skills of patients and professionals, and privacy and data security concerns.

From 2021 to 2023, PHR adoption improved in general hospitals, academic hospitals, and private medical clinics in the Netherlands within several domains of PHR adoption. However, several barriers remained, including technical barriers, financial constraints, and privacy and security concerns. To overcome these barriers, the technical integration of available data from the electronic health record within the PHR should be improved and privacy-related issues should be resolved. Consistent communication about the potential of PHRs is required to increase the awareness that will enhance both PHR engagement and adoption by the target groups, patients, and health care professionals.