How Have Specialist Physicians' Priorities for EHR Development Evolved in Eleven Years? Results from Four Cross-Sectional Surveys in Finland.

Electronic Health Record (EHR) systems continually evolve to meet the demands of user organizations, national authorities, and end users. Finland, a digital health pioneer, encountered challenges like system fragmentation and interoperability despite early EHR adoption. The rollout of national health information exchange (Kanta) services sought to address these issues but also introduced new usability concerns. In national cross-sectional usability surveys conducted among physicians in 2010, 2014, 2017, and 2021, we asked respondents to select five most pertinent development targets from a predefined list. This study analyzed specialist physicians' responses by study year and specialty group: surgical, nonoperative medical, psychiatry, general practice (GP), occupational healthcare (OH), and anesthesiology and intensive care. Compared to earlier years, unexpected EHR downtime and slowness became less urgent across all specialties in 2021. In 2010, summary views were a high priority (36-61% in other groups; 18% in OH). After EHR development, this priority decreased in 2014-17 (18-26%), but rose again, particularly among GPs and OH physicians (60-65%; 37-43% for others) in 2021, likely due to increased awareness of its potential. In 2021, the usability development of Kanta Services became a top priority across all specialties. Monitoring the evolution of physicians' priorities remains crucial for understanding the impact of EHR-system and working environment changes.