Electronic health records across Europe: adoption, digital maturity, and implications for quality and safety of care

Ana Luisa Neves, Ferdinando Petrazzuoli, Robert D Hoffmann, Heidrun Lingner, Hans Thulesius, Le Reste Jean-Yves

Keywords: electronic health records; quality and safety of care; patient-centred care


Electronic health records (EHR) are transforming health services by providing new mechanisms for accessing personal medical records, submitting incident reports, and communicating across care settings. However, despite government efforts all over Europe, little is known about current adoption rates and levels of digital maturity in different countries. Furthermore, despite the growing body of evidence on the theorised benefits of EHR on quality and safety of care, there is still a considerable gap between the predicted and demonstrated implications.

Research questions:

The aims of this work are to characterise EHR use (adoption and digital maturity) by Primary Care Physicians (PCP) across Europe, and to evaluate their perspectives on the impact on the quality and safety of care.


The study will use an online questionnaire survey of PCPs from several European countries. Recruitment will start in June 2020 and will be completed in June 2021. Each national lead will recruit PCPs through their contact networks directly by email, at a minimum number of 25 participants. Snowballing sampling will be used if required. The survey will include multiple choice questions to characterise the system features and adoption rates. Digital maturity will be evaluated using the “Patient-centered Framework for Evaluating Digital Maturity of Health Services”. Free-text questions will be used to assess perspectives on quality and safety of care, using a SWOT analysis approach. Quantitative data will be analysed using SPSS to explore relationships between perceptions and participants/countries characteristics. Qualitative data will be analysed in InVivo using the framework analysis method.


Ongoing study with no results yet.


EHR usage is far from universal, but we need to gather data on the current state of usage across Europe, as well as PCP beliefs regarding safety and quality of care. This data will allow us to inform heath management personnel about the situation and needs.

Points for discussion:

1. What comments and recommendations do you have for the study researchers?

2. What drawbacks and possible limitations do you see in our proposed methodology?

3. Are you interested in joining and being your country’s coordinator?