Enhancing the Usability and Implementation of Electronic Prescribing Through a Living Lab Approach: Experiences from the eRIKA Project (Preprint)

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BACKGROUND The integration of eHealth solutions into routine healthcare remains challenging despite their potential to improve care quality and efficiency. Many digital health interventions struggle to scale beyond pilot phases due to usability issues, poor alignment with clinical workflows, limited interest-holder involvement and structural barriers. Living Labs (LLs) have emerged as an approach to address these challenges by enabling co-design and iterative testing of eHealth tools. LLs promote collaboration among patients, healthcare professionals, developers, and policymakers. However, systematic insights into their practical implementation are still limited. OBJECTIVE This study explores the use of a LL approach to create and adapt project workflows dynamically, as well as its potential as a methodological framework for developing an implementation plan for a digital prescribing workflow (eRIKA). The analysis focuses on intervention-level insights identified throughout the LL process. The study also reflects on limitations of the approach. METHODS The eRIKA project was implemented using an LL approach to iteratively refine a digital prescribing workflow in collaboration with end-users. The co-design process was structured into four thematic sprints. Workshops with general practitioners (GP), pharmacists, medical assistants and pharmacy assistants were conducted to test software prototypes and gather feedback. Participants were recruited from six GP practices, six pharmacies, and one hospital in Germany. Data were collected through audio-recorded workshops and the thinking aloud method. Thematic analysis was used to analyze participants’ feedback regarding technical integration, usability, and implementation feasibility of the eRIKA system within routine care settings. RESULTS The results show a need for seamless technical integration with existing primary care systems and a stable infrastructure, alongside user-friendly, intuitive interfaces that avoid disrupting established workflows. Practically valued features include integrated medication checks, real-time inventory visibility, and the ability to document over-the-counter medications in patient records. Concerns were raised around duplicated workflows, excessive alerts, insufficient training, and unresolved questions about data accuracy, particularly regarding patient-entered information. A desire for direct, digital communication channels was expressed. At a broader level, the LL identified barriers related to the national health IT infrastructure as well as difficulties in cross-sectoral collaboration. CONCLUSIONS Aligning with previous research, the results highlight concerns around workload, system interoperability, role and responsibility, as well as regulatory barriers to implementation. Beyond these established challenges, the results also surface interprofessional tensions between GPs and pharmacists regarding the extent of data sharing required for effective pharmaceutical counselling. Overall, applying the LL method provides meaningful, actionable insights for refining and adapting complex interventions to specific contexts. Further research should explore standardized evaluation frameworks for LL implementations, considering both process optimization and measurable health outcomes, but also the involvement of macro-level interest-holders. INTERNATIONAL REGISTERED REPORT RR2-10.2196/87277

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