Table 2.

Practical implications to support access to the ePA^a application.

Process phase	Empirical finding	Practical implications
Phase 1: orientation	Participants began registration without a clear understanding of the required applications, documents, PINsb, device functions, or available authentication routes. Information was sometimes incomplete, outdated, or insufficient for specific situations.	Provide centralized, up-to-date, and pathway-specific guidance, including a preregistration checklist of all technical and administrative requirements.
Phase 2: technical entry	Switching between applications, identification services, and technical interfaces increased coordination work. Device requirements such as NFCc capability were not always communicated before the process began.	Minimize transitions between applications and clearly communicate device and system requirements before users enter the authentication pathway.
Phase 3: verification	Multistep verification, technical failures, unclear feedback, and inconsistencies in administrative data prevented users from completing authentication or required repeated attempts.	Simplify verification procedures and provide actionable error messages that identify the problem and explain the next step or available support.
Phase 4: interruption	Postal procedures, waiting periods, and technical disruptions interrupted progression and required users to reconstruct or repeat previously completed steps.	Preserve completed steps and enable users to resume the process after interruptions, supported by clear progress and status information.
Phase 5: transition to initial use	Successful registration did not necessarily lead to initial or continued use when participants could not identify an immediate practical benefit.	Provide a brief postregistration orientation showing relevant initial use cases and the information or functions available in the ePA application.
Cross-phase factors	Across the pathway, participants relied on digital competence, prior experience, persistence, and self-efficacy to understand requirements, resolve problems, and resume interrupted procedures. The process was often experienced as an individual problem-solving task without systematic support.	Provide consistent and easily accessible support throughout the access pathway, including telephone or in-person assistance, to reduce reliance on individual coping resources.

^aePA: elektronische Patientenakte.

^bPIN: personal identification number.

^cNFC: near-field communication.