Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace
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OBJECTIVE: To evaluate the policy making process, implementation by NHS organisations, and patients' and carers' experiences of efforts to introduce an internet accessible personal electronic health record (HealthSpace) in a public sector healthcare system. DESIGN: Mixed method, multilevel case study. SETTING: English National Health Service; the basic HealthSpace technology (available throughout England) and the advanced version (available in a few localities where this option had been introduced) were considered. MAIN OUTCOME MEASURES: National statistics on invitations sent, HealthSpace accounts created, and interviews and ethnographic observation of patients and carers. Data analysis was informed by a socio-technical approach which considered macro and micro influences on both adoption and non-adoption of innovations, and by the principles of critical discourse analysis. PARTICIPANTS: 56 patients and carers (of whom 21 opened a basic HealthSpace account, 20 had diabetes but were not initially using HealthSpace, and 15 used advanced HealthSpace accounts to exchange messages with their general practitioner), 3000 pages of documents (policies, strategies, business plans, minutes of meetings, correspondence), observational field notes, and 160 interviews with policy makers, project managers, and clinical staff. RESULTS: Between 2007 and October 2010, 172 950 people opened a basic HealthSpace account. 2913 (0.13% of those invited) opened an advanced account, compared with 5-10% of the population anticipated in the original business case. Overall, patients perceived HealthSpace as neither useful nor easy to use and its functionality aligned poorly with their expectations and self management practices. Those who used email-style messaging were positive about its benefits, but enthusiasm beyond three early adopter clinicians was low, and fewer than 100 of 30 000 patients expressed interest. Policy makers' hopes that "deploying" HealthSpace would lead to empowered patients, personalised care, lower NHS costs, better data quality, and improved health literacy were not realised over the three year evaluation period. CONCLUSION: Unless personal electronic health records align closely with people's attitudes, self management practices, identified information needs, and the wider care package (including organisational routines and incentive structures for clinicians), the risk that they will be abandoned or not adopted at all is substantial. Conceptualising such records dynamically (as components of a socio-technical network) rather than statically (as containers for data) and employing user centred design techniques might improve their chances of adoption and use. The findings raise questions about how eHealth programmes in England are developed and approved at policy level.
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Attempts to introduce shareable electronic records by first encouraging patients to enroll, and then hoping that health care providers and organisations will follow, have failed due to resistance of clinicians and healthcare organisations.
“For example, attempts to introduce shareable electronic records by first encouraging patients to enroll, and then hoping that health care providers and organisations will follow, have failed due to resistance of clinicians and healthcare organisations [27, 28].”
From Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study (2016) · cites this paper as [27]
These findings suggest the need for closer proximity between innovation design and evaluation, so that critical insights might usefully feed back into design and implementation, ensuring interventions are 'minimally disruptive' for recipients.
“Additionally, these findings suggest the need for closer proximity between innovation design and evaluation, so that critical insights might usefully feed back into design and implementation [11,13] ensuring interventions are ‘minimally disruptive’ for recipients [42].”
From Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study (2012) · cites this paper as [13]
Previous studies have described the challenges brought by the new 'work' and scrutiny associated with such interventions, and the disruption of normalised everyday practices and interactions regarding management has been recognised as a major barrier to the integration of e-health interventions into routine care and management.
“Previous studies have described the challenges brought by the new ‘work’ and scrutiny associated with such interventions [12,38,39] and where the disruption of normalised everyday practices and interactions regarding management have been recognised a major barrier to the integration of e-health interventions into routine care and management [13,40,41].”
From Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study (2012) · cites this paper as [13]
Existing evidence on eHealth readiness mainly relates to organizational readiness within the health service or the readiness of health professionals, patients, or carers for a specific single digital health service.
“However, the existing evidence mainly relates to organizational readiness within the health service [17,18] or the readiness of health professionals [19-21], patients or carers for a specific single digital health service [22].”
Previous research relating to the use of personal electronic health records has demonstrated less public and professional appetite than anticipated.
“Previous research relating to the use of personal electronic health records has demonstrated less public and professional appetite than anticipated [22,44].”
ICT programmes in health care fail partly because people do not use the technologies.
“Information and communication technology (ICT) programmes in health care fail partly because people do not use the technologies.”
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- Authors
- Greenhalgh, T., Hinder, S., Stramer, K., Bratan, T., & Russell, J.
- Affiliations
- Queen Mary University of London (GB)
- University College London (GB)
- Corresponding author
- Greenhalgh, T.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-11-16
- Volume
- 341
- Issue
- nov16 1
- Pages
- c5814-c5814
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2982892
- OpenAlex
- W2053939792
- Cited by
- 343
- References
- 55
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 13 · 2023: 14 · 2022: 16 · 2021: 25 · 2020: 21 · 2019: 24 · 2018: 26 · 2017: 35 · 2016: 31 · 2015: 27 · 2014: 29 · 2013: 29 · 2012: 21
- FWCI
- 40.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- technology adoption, non-adoption, patient and caregiver experiences, socio-technical approach, patient empowerment, self-management, user-centered design, patient-clinician communication, health information needs, health literacy, critical discourse analysis, patient-centered care
- MeSH terms
- England, Health Policy, Humans, Patient Acceptance of Health Care, Patient Participation, Software, State Medicine, Internet, Electronic Mail, Electronic Health Records
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