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

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.