Table 3.

Topics influencing the implementation of the PHR, according to care providers, including examples

Topic	Example
Training and guidance	‘Yes, that was not really difficult. The PHR, seeing health values, it is not very difficult.’
	‘… No idea how I had to work, so we sat with the manual next to the patient, we went through it step by step. But then the patient also had enough of it, no matter how positively you started it, at some point you notice your own frustration.’
	‘It was still vague what exactly we had to do and what was expected from us.’
	‘Well, after training you still need to try it yourself and look at the platform and the PowerPoint again. You need to show initiative by yourself, otherwise it is difficult.’
Compatibility with other systems	‘At this time, we work with three different systems: the PHR, our own EHR, and the telemonitoring system. We constantly need to switch between these three systems, that is just difficult. It is just not workable that way.’
	‘It should be user-friendly. You should not have four systems in which you have to fill the same information.’
	‘We must keep track of two systems, which is time consuming, it is not possible to have a link between the PHR and the EHR at the same time’
Integration in daily care routines	‘I must honestly say that we forget to look at the PHR. That is also because it is not in your daily routine.’
	‘I don’t feel like going to look there every day, but maybe once every month to take a look at what I can improve and how.
Use by patients	‘They are often also excited but in practice they still do not use it.’
	‘Because he did not fill in the medication and co-morbidities, while we clearly stated during inclusion, that they had to fill in so we could take it into account when health values deviate. The first person did not do it, the second neither, then you fall back on your own system.’
Usability	‘There were a lot of things in this platform, that did not work. In addition, it was not really an enchanting site and especially in this hospital very slow. We did not really work with the PHR, I must say.’
	‘You can see recent values, and the last 2 weeks. That is also a limitation, because sometimes you want to see for a longer term.’
Communication via PHR	‘Implement a certain learning element. For example, that the system indicates: ‘You have now gained two pounds, do you think that the care giver should take action or are you capable to do something on your own?’
	‘For example, a digital contact with the patient. Especially with younger patients, or people who are used to e-mail. Contact them via this way.’