Design propositions for nudging in healthcare: Adoption of national electronic health record systems

Author:

Steinhauser Stefanie1ORCID,Raptis Georgios23ORCID

Affiliation:

1. Health Economy and Entrepreneurship, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany

2. Computer Science / eHealth, OTH Regensburg, University of Applied Sciences, Regensburg, Germany

3. Regensburg Center of Biomedical Engineering, Regensburg, Germany

Abstract

Objectives Electronic health records (EHRs) are considered important for improving efficiency and reducing costs of a healthcare system. However, the adoption of EHR systems differs among countries and so does the way the decision to participate in EHRs is presented. Nudging is a concept that deals with influencing human behaviour within the research stream of behavioural economics. In this paper, we focus on the effects of the choice architecture on the decision for the adoption of national EHRs. Our study aims to link influences on human behaviour through nudging with the adoption of EHRs to investigate how choice architects can facilitate the adoption of national information systems. Methods We employ a qualitative explorative research design, namely the case study method. Using theoretical sampling, we selected four cases (i.e., countries) for our study: Estonia, Austria, the Netherlands, and Germany. We collected and analyzed data from various primary and secondary sources: ethnographic observation, interviews, scientific papers, homepages, press releases, newspaper articles, technical specifications, publications from governmental bodies, and formal studies. Results The findings from our European case studies show that designing for EHR adoption should encompass choice architecture elements (i.e., defaults), technical elements (i.e., choice granularity and access transparency), and institutional elements (i.e., regulations for data protection, information campaigns, and financial incentives) in combination. Conclusions Our findings provide insights on the design of the adoption environments of large-scale, national EHR systems. Future research could estimate the magnitude of effects of the determinants.

Publisher

SAGE Publications

Subject

Health Information Management,Computer Science Applications,Health Informatics,Health Policy

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