Implementation of EPR-Youth, a Client-Accessible and Multidisciplinary Health Record; A Mixed-Methods Process Evaluation

Janine Benjamins; Jan-Gerrit Duinkerken; Gerlinde den Hamer-Jordaan; Romay Canfijn; Rianne Koster; Emely de Vet; Annemien Haveman-Nies

doi:10.5334/ijic.6905

Implementation of EPR-Youth, a Client-Accessible and Multidisciplinary Health Record; A Mixed-Methods Process Evaluation

Int J Integr Care. 2023 Jun 16;23(2):26. doi: 10.5334/ijic.6905. eCollection 2023 Apr-Jun.

Authors

Janine Benjamins^{1

2}, Jan-Gerrit Duinkerken³, Gerlinde den Hamer-Jordaan², Romay Canfijn², Rianne Koster¹, Emely de Vet², Annemien Haveman-Nies^{2

4}

Affiliations

¹ Icare JGZ, Blankenstein 550, 7943 PA, Meppel, the Netherlands.
² Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands.
³ Stichting Jeugd Noord Veluwe, Stationsplein 18a, 8071 CH, Nunspeet, the Netherlands.
⁴ GGD NOG, Rijksstraatweg 65, 7231 AC, Warnsveld, the Netherlands.

Abstract

Introduction: Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients' involvement in care. To achieve this, three Dutch organizations providing 'care for youth' developed a fully client-accessible electronic patient record (EPR-Youth).

Objective: To evaluate the implementation of EPR-Youth and to determine barriers and facilitators.

Methods: A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders.

Findings: Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals' doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit.

Conclusion: The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in 'care for youth' was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary.

Keywords: Electronic Health Records; child health services; child welfare; implementation; integrated care.

Grants and funding

This study has been funded by ZonMw, project nr 736300019. Before granting the funds, ZonMw has had the project proposal reviewed. ZonMw has played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.