Evaluation of shared EHR services in primary healthcare centers and their rural community offices: the twister story.

Ten years after primary, secondary, and tertiary healthcare facilities in Crete were connected in HYGEIAnet, one of the first regional health information networks worldwide, the Twister project addressed the practical challenge of delivering integrated eHealth services to remote healthcare facilities in Crete and the south Aegean. A hybrid network infrastructure comprising terrestrial broadband, wireless, and satellite segments provided connectivity among distributed healthcare organizations. A fast-track methodology of continuous training and evaluation was used to encourage the wide adoption of EHR services in primary healthcare centers and their remote community offices, eTraining in prehospital emergency management, and medical collaboration. For the evaluation of Twister, health professionals using EHRs and citizens visiting the healthcare facilities provided their attitudes and perceptions on eHealth. Although eHealth is viewed differently by citizens and health professionals, both groups consider the EHR as an important part of the daily medical practice. However, continuous training, practical incentives, and awareness initiatives are necessary to increase the use of EHRs and the social embedding of eHealth in rural areas.