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Patient access to electronic health records: Differences across ten countries
Authors:Anna Essén  Isabella Scandurra  Reinie Gerrits  Gayl Humphrey  Monika Alise Johansen  Patrick Kierkegaard  Jani Koskinen  Siaw-Teng Liaw  Souad Odeh  Peeter Ross  Jessica S. Ancker
Affiliation:1. SIR (Stockholm School of Economics Institute for Research), Stockholm School of Economics, Saltmätargatan 13-17, 4th floor, 113 83 Stockholm, Sweden;2. Karolinska Institutet, Learning Informatics Management and Ethics Medical Management Center, Widerströmskahuset, Tomtebodavägen 18 A, plan 4-5, 171 77 Stockholm, Sweden;3. Örebro University School of Business, Informatics, SE-701 82 Örebro, Sweden;4. Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands;5. National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Glen Innes, Auckland 1072, New Zealand;6. Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway;g. Innovation, Networks & Knowledge (INK) University of Michigan 330 Packard, 2325 Perry Ann Arbor, MI 48104-2321, USA;h. University of Turku, Information Systems Science, Turku, Finland;i. UNSW Medicine Australia, Sydney, NSW 2052, Australia;j. Academic GP Unit, SW Sydney Local Health District and Ingham Institute, Australia;k. University Claude Bernad lyon 1, Department of informatics, Nautibus, 8-10, Bd Niel Bohr, 69100 Villeurbanne, France;l. Tallinn University of Technology (TUT), Department of Health Technologies, Akadeemia tee 15A, 224-228, 12618 Tallinn, Estonia;m. East Tallinn Central Hospital, Diagnostic Clinic, Ravi str. 18, 10138 Tallinn, Estonia;n. Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA;o. Department of Clinical Medicine, the Artic University of Norway (UIT), Tromsø, Norway
Abstract:

Objectives

Patient-accessible electronic health records (PAEHRs) are being implemented at international scale. Comparing policies and systems could allow countries to learn from each other to address global and nation-specific challenges. We compare national PAEHR policy (hard and soft regulation) and services in 10 countries.

Methods

PAEHR policy and system documentation was gathered from Australia, Denmark, Estonia, Finland, France, the Netherlands, New Zealand, Norway, Sweden and the United States. A basic analytic model for policy analysis was used to delimit our focus to policy content, followed by an inductive thematic analysis across countries, in which we clustered initial themes into a set of categories of PAEHR service “approaches” related to three specific content areas.

Results

Although all 10 countries ensured some patient rights to access medical records, policies and systems were highly variable, as were the technological processes arising from these. In particular, three policy areas showed great variability. Depending upon country of origin, a patient would encounter differences in: login procedures (security), access to own and other patients’ data during adolescence (user rights), and types of medical data made available to the patient (data sets).

Conclusions

Individuals encounter very different access rights to their medical data depending on where they live. Countries may be able to develop improved policies by examining how other nations have solved common problems. Harmonizing policies is also an initial step likely to be needed before cross-national PAEHRs could be possible.
Keywords:Patient accessible electronic health records  Patient health records  Patient portal  International comparison
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