Table 1 Implementation challenges and facilitators

Working conditions

High demand, low support

Supportive working environment

Stress, high work load

Support by nurses

Limited resources

Support by interns/students

Strained relationships with patients

Patient management

Low patient adherence to the PHR

High patient adherence to the PHR

New PHRs are handed out to the same patient multiple times

Encouraging patients to retrieve their PHR in case they have forgotten

Patients do not receive appropriate information about the PHR

Patients receive appropriate information about the PHR and understand the relevance for their medical treatment

Local PHR practices

Low physician adherence to the PHR

High physician adherence to the PHR

Physicians receive no or insufficient information about the PHR before implementation

Strong involvement by nurses, e.g. preparing the PHR prior to the consultation

Documenting in multiple paper-based or electronic health records

Printing electronic PHR and storing it in the patient-held PHR’s document pocket to lower workload

Illegible handwriting

Using the PHR as a folder for all relevant documents

Potential benefit of a patient-held PHR

Low perceived benefit in settings of low fragmentation

High perceived benefit in settings of high fragmentation

Well-established electronic PHR accessible to all health care providers in the facility

Absence of electronic PHR or more than one electronic PHR system

Small number of personnel

Large number of personnel

Close collaboration and personal communication with external doctors prior to PHR introduction

Dissatisfaction with availability of medical history and communication with external doctors prior to PHR introduction

Mono-disciplinary care settings

Different professions and medical specialties involved in care provision