Trustworthiness of EHRs: Key Factors from a User-Centered Study in Germany

Abstract Background The integration of digital technologies, particularly Electronic Health Records (EHRs), promises substantial improvements in patient care and cost reductions. However, the success of EHRs depends heavily on patient trust and usage, which are influenced by their control over data visibility, storage, and sharing. Identifying the factors that enhance the perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings. Methods Participants (N = 30) first interacted with an interactive EHR prototype, then evaluated its trustworthiness and suggested improvements during semi-structured interviews. These interviews were transcribed and analyzed using thematic analysis to identify key themes affecting perceptions of the EHR’s trustworthiness. Results Through thematic analysis, we developed a categorical system encompassing five principal themes: provider reputation, information quality, system characteristics, user control, and user feedback. The analysis revealed that deficiencies in design and usability indirectly affect perceptions of privacy and data security. Conclusions Our study underscores the critical role of contextual factors-including provider reputation, strategic IT partnerships, and user feedback-in cultivating trust in Electronic Health Record (EHR) systems. Addressing privacy concerns and bolstering user trust necessitates not only a professional approach to design and usability but also clear communication about adherence to rigorous data privacy and security standards. In Germany’s tightly regulated environment, clearly communicating EHR security standards is crucial. Enhancing trust also involves robust customer support, user control over their data, and leveraging social proof like high download rates or positive reviews. These approaches could significantly improve EHR acceptance and trust in digital health across the country. Key messages • The perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings. • Effective communication and design are critical for building trust in digital health technologies. Trust in EHRs grows with transparent data policies and empowering user controls.