Abstract
BACKGROUND: The integration of electronic health records (EHRs) in mobile care presents complex challenges in German-speaking countries (DACHL region: Germany, Austria, Switzerland, and Liechtenstein). While digitalization efforts are advancing, fragmented infrastructure, unclear access rights, and inconsistent implementation strategies hinder interdisciplinary data exchange, particularly in mobile nursing and care settings. OBJECTIVE: This study aimed to explore expert perspectives on the requirements and challenges for cross-sectoral integration of EHRs in mobile care within the DACHL region; essential system functions and support structures; and the expected impact of digital data exchange on care quality, workload, and collaboration. METHODS: A modified Delphi approach was used, comprising 2 phases. In phase 1, qualitative expert interviews were conducted between January and April 2024, using a semistructured interview guide. Interviews were analyzed using qualitative content analysis to derive key findings and thematic groups. These results informed the design of a structured online survey. In phase 2, 2 Delphi rounds were carried out (round 1: April/May 2024; round 2: July/August 2024). The first round included 159 items rated on a 4-point Likert scale and a ranking task of EHR functions. In the second round, only items without prior consensus and the top-ranked functions were reassessed. Consensus was defined as ≥75% agreement or disagreement among participants. RESULTS: Nineteen experts participated in qualitative interviews, 18 in the first survey round, and 15 in the second round (retention rate: 79%). Consensus was reached for 141 of the 159 survey items (88.7%). Experts emphasized the importance of open, interoperable systems; standardized terminologies; and agile development tailored to mobile care. High agreement was identified for the relevance of key EHR functions, with diagnoses, medication lists, assessments, and medical history showing the highest ranking scores in round 2 (32, 27, 19, and 18 points of 48 possible points, respectively). Usability and differentiated support structures were considered essential for successful implementation. Cross-border data exchange, telemonitoring, and artificial intelligence integration were seen as valuable, while the topic of access rights, particularly for assistant roles, provoked the most disagreement, indicating a need for further clarification in policy and practice. All panelists (17/17, 100%) endorsed open, interoperable systems and rigorous usability testing, whereas only 23% (3/13) agreed on granting full data access rights to assistant roles. Overall, experts predicted that interoperable EHRs would improve patient safety (15/17, 88%), reduce duplicate documentation (16/17, 94%), and enhance interdisciplinary collaboration (16/16, 100%). CONCLUSIONS: Experts in the DACHL region broadly agreed on the functional and structural key requirements for effective digital data exchange in mobile care. Interdisciplinary EHR implementation must emphasize interoperability, context-sensitive access policies, and usability. The findings provide a foundation for policy development, system design, and future research, contributing to safe and efficient digital care delivery across sectors and borders.