Usage and Perceptions of Electronic Patient Records Experienced by Users and Nonusers in the Canton of Vaud, Switzerland: Mixed Methods Study

Background: Electronic patient records (EPRs) have shown potential to improve health care delivery, coordination, and patient engagement. In Switzerland, the development of a national EPR is supported by the Confederation, while its deployment is carried out by the cantons through EPR communities. Since health policy and the organization of health systems are entrusted to cantonal governments, each of the 26 Swiss cantons must decide its strategy for the implementation and application of EPRs within its jurisdiction. The canton of Vaud has joined with other French-speaking cantons (Geneva, Valais, Fribourg, and Jura) in organizing the implementation of the EPR through the CARA association since 2018. By June 2025, approximately 32,350 individuals have opened an EPR (Dossier électronique du patient) through CARA, accounting for 28% of all EPRs opened nationwide at that time. Objective: This study aimed (1) to document patients' use of EPR in the canton of Vaud and to examine the user profiles; and (2) to explore users' and nonusers' perceptions regarding EPR benefits and barriers. Methods: This mixed methods study was conducted in 2 phases. First, a quantitative questionnaire examined EPR user profiles (eg, demographics and health status). Health literacy and digital health literacy were assessed using the HLS19-Q12-CH (Health Literacy Survey 2019-2021) and HLS19-DIGI-CH (Digital Health Literacy) scales in French. Second, qualitative semistructured interviews explored experiences and perceptions of users and nonusers through thematic analysis. Data from both phases were integrated during interpretation. All analysis was conducted in French with quotes translated for publication. Results: The population included 839 patients with EPRs (early adopters from December 2021 to December 2023) and a matched control group. Overall participation was 19.3% (324/1678), with higher participation among EPR users (255/839, 30.4%) than nonusers (69/839, 8.2%). Early adopters were predominantly male (185/255, 72.5%), highly educated (155/255, 60.8%), affected by chronic illness (204/255, 80%), and with extensive health care networks (80% consulted 2 or more health care professionals in the last 3 months). The vast majority (249/253, 98.4%) had a general practitioner. While only a minority (76/252, 30.2%) of early adopters were satisfied with the service provided by the EPR, a majority (172/254, 67.7%) would recommend it to their family and friends. Qualitative analysis identified themes that influence EPR adoption, including the contextual environment, level of health literacy, EPR as a tool, professionals' resistance to EPR, and level of engagement with digitalization. Conclusions: This study identified early EPR adopters as predominantly highly educated males with chronic diseases and a regular general practitioner. Despite moderate satisfaction with the current implementation, most users recommend the system to others, suggesting a belief in its potential value. Important questions are raised regarding EPR accessibility, limited adoption by professionals, and potential digital health disparities in the general population.