Development of a Regional Digital Health Record for Geriatric Health Care in Rural Areas: Community-Based Participatory Research Approach (Preprint)

BACKGROUND Geriatric patients are often treated by several healthcare providers at the same time. The spatial, informational, and organizational separation of these healthcare providers can hinder an effective treatment of geriatric patients. OBJECTIVE The aim of this study was to develop a regional Digital Health Record (abbreviated in German as ReDiFa) in order to improve health information exchange in geriatric treatment. This study also evaluated the usability of ReDiFa and seeks to identify barriers and facilitators for its implementation. METHODS The development of ReDiFa followed the Community-Based Participatory Research Approach (CBPR) and involved various geriatric healthcare professionals in all stages of development: identification of suitable regions for later implementation, identification of regional stakeholders, identifying specific, regional needs, development of a content concept, programming and testing of ReDiFa. Primary outcomes were usability of ReDiFa, expected implementation barriers and facilitators and the quality of the developmental process. Data were collected and analyzed by using a mixed-method approach. RESULTS 3 focus regions were identified, 22 geriatric healthcare providers participated in the development of ReDiFa and 11 workshops were conducted between October 2019 and September 2020. 12 participants responded to a questionnaire. Main results were, that ReDiFa should support the exchange of assessments, diagnoses, medication, assistive device supply and social information. The ReDiFa was expected to be able to improve the quality and continuity of care. Main barriers expected for implementation were: lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. CONCLUSIONS Participating healthcare professionals share similar motivations for developing ReDiFa including improved quality of care, reduction of unnecessary examinations, and more effective healthcare provision. An overly complicated registration process for healthcare professionals and the patients' free choice of their healthcare providers hinder the effectiveness of ReDiFa and result in incomplete patient health information. However, the web-based design of ReDiFa bridges interoperability problems which exists due to different technical and organizational structures of the involved healthcare facilities. ReDiFa is better accepted by healthcare professionals which are already engaged in an inter-disciplinary, geriatric-focused network. This might indicate that pre-existing cross-organisational structures and processes are prerequisites for using health information exchange systems. The participatory design supports the development of technologies adaptable to regional needs. Healthcare providers are interested in participating in the development of a health information exchange system, but they often lack the required time, knowledge and resources.