Design propositions for nudging in healthcare: Adoption of national electronic health recordsystems
- Objectives: Electronic health records (EHRs) are considered important for improving efficiency and reducing costs of ahealthcare system. However, the adoption of EHR systems differs among countries and so does the way the decision to par-ticipate in EHRs is presented. Nudging is a concept that deals with influencing human behaviour within the research streamof behavioural economics. In this paper, we focus on the effects of the choice architecture on the decision for the adoption ofnational EHRs. Our study aims to link influences on human behaviour through nudging with the adoption of EHRs to inves-tigate 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 ana-lyzed 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 archi-tecture elements (i.e., defaults), technical elements (i.e., choice granularity and access transparency), and institutional ele-ments (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.