System-level barriers to patient engagement with electronic medical records

Objective: Electronic medical records (EMRs) can support patient-centered care, but system-level barriers often limit how patients engage with EMR systems. This study explored the system-level barriers and enablers to patient engagement with EMRs from the perspectives of healthcare leaders. Methods: Semi-structured interviews were conducted with 20 participants in senior EMR-related roles across healthcare organizations in two Australian states. Data were analyzed using reflexive thematic analysis to identify key system-level influences on patient engagement. Results: Seven themes were identified: 1) EMRs for digital storage, not connection, 2) Privacy rules create challenges to accessing information, 3) Communication barriers when using EMRs, 4) Limited use of EMR features, 5) Physical and workflow barriers reduce EMR accessibility, 6) EMR information is too complex for patients, and 7) Underutilization of patient portals. Conclusion: This study highlights that system issues, not just individual practice, constrain patient engagement with EMRs. Barriers to engagement include clinician-focused EMR design, unclear or restrictive policies, and gaps in infrastructure and training. Addressing these challenges requires a shift to patient-centered EMR design, policy reform, and improved implementation strategies that enable patients to be active participants in their care. Patient or Public Contribution: Patient representatives/consumers were members of the Research Committee and contributed to project governance, development, and review.