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This study uses three case studies to investigate how the installed base affects Electronic Health Records (EHR) implementation in European hospitals: i) transition from paper-based records to EHRs; ii) replacement of an existing EHR with a similar system; and iii) replacing existing EHR system with a radically different one. Using a meta-analysis approach, the study employs the theoretical framework of Information Infrastructure (II) to analyze user satisfaction and resistance. Results show that the existing infrastructure and time factor significantly impact EHR outcomes. Implementation strategies that build upon the current infrastructure and offer immediate user benefits yield higher satisfaction rates. The study highlights the importance of considering the installed base and adapting implementation strategies to maximize EHR system benefits.

The Electronic Health Record (EHR) has been a principal component in transforming healthcare from traditional pen-and-paper documentation procedures to highly digitalized and interoperable environments. Implementation of EHR is complicated, and success is dependent on the users accepting and utilizing the system to its potential. The present qualitative multi-center study investigated health professionals perceived system usability, user resistance and productivity five to eight years after implementation of a modern EHR, across three European cites. Data was collected with semi-structured interviews with experienced health professionals that had work experience before and after implementation of the EHR. Overall, the respondents considered their EHR to have good usability, reported a low degree of user resistance, and were ambiguous on how the EHR affected their perceived workload at the present, but retrospectively reported that the road towards the present state of satisfaction was not without hurdles.

Dropout and fatigue is present in most research projects. The present project Chronic Pain includes Fibromyalgia patients and applies a user-centered design approach. Surprisingly to the research group, two years into the project there is zero dropout. As a step towards designing a survey to investigate the patient adherence to the project, the characteristics of the user-centered design process are described in this paper.

User-centred design involves end-users or user groups during all the parts of the development process. The research project Chronic Pain aims to develop a shared decision making application for patients and physicians, addressing individually adapted pain treatment. The project employs a user-centred design process, and in middle of it, Covid-19 pandemic social distancing restrictions were imposed. This paper presents how the user-centred design process together with a patient organisation was transformed to a digital approach and the experiences from performing a remote co-creation user workshop. The digital approximation had a satisfactory result and the main contribution lies in the sharing of recommendations for how to practically apply a remote user-centred design methodology.

Chronic pain patients constitute a large and heterogeneous patient group and it is important to build tools and methods that can identify efficient treatment options for each individual patient. It is estimated that 20-30% of the population has suffered from chronic pain and this imposes enormous costs on society and the national welfare programs. The research project Chronic Pain addresses the problem of how to provide patients and physicians with relevant, valid and adapted decision alternatives in a shared decision making tool. This paper presents the results from co-creation workshops early in the user-centred design process of the chronic pain mobile application. The end-users contributed in mapping the user needs and requirements, and made paper prototyping of the user interface. The main contribution lies on how a user-centred design methodology can be applied in a clinical development context.

Technical platforms form the fundament on which IT systems and Electronic Health Records (EHRs) are implemented. The use of either open or proprietary standards and technologies for information modelling and interoperability have implications for how clinical and health data is handled and made available for the system users. In Norway, two different EHRs are procured in different health regions of the Specialist healthcare service. The two platforms are characterized as one being open platform-based and the other being closed platform-based. The study aims to identify and describe consequences and implications related to two different platform approaches for EHRs from an end-user perspective. The study will employ three methods of data capturing; scoping study, interviews, and questionnaires. Data will be systematically analyzed through proven methods. Interviews and questionnaire data will be gathered from European hospitals having implemented EHRs in recent years. Results will be compared to the Norwegian context. The technical platform used for health IT systems in general, and the EHR specifically, can have substantial consequences for clinicians and organization of work. Closed platform-based EHRs still constitutes the majority of the market, but open platform approaches are rapidly gaining popularity. An assessment of the consequences related to different platform designs can shed light on the implications the chosen technical approach will have on clinical and organizational practice.