Infrastructure or Knowledge? Investment Priorities for Promoting the Adoption of Digital Health Tools

As COVID-19 pandemic accelerated the digitalization of healthcare, prompting large public investments in the sector, it remains unclear whether the initial shock generated a stable adoption of digital health tools and the full exploitation of their functional- ities. Using the case of the Electronic Health Records (EHR) in Italy, we show that a remarkable increase in its use in the aftermath of the pandemic is not necessarily associated to an equal understanding of its scope and functions by potential patients. Exploiting a 2020 reform and variation in pandemic exposure, we show that a one- standard-deviation increase in exposure increased EHR reported use by 39%, driven by records feeding and medical needs. We then leverage a December 2024 national media campaign on the EHR to conduct an original survey focused on its adoption. Among the main evidence is that the acknowledgment of the EHR existence does not translate into effective knowledge, access, or regular use. Engagement is more strongly associated with trust and digital attitudes than with most traditional socio-economic factors. Progress along the adoption chain depends on perceived needs, institutional confidence, and willingness to engage with digital tools. To provide an understanding of how to increase perceived benefits and willingness to engage with the EHR, we ran- domize information treatments based on the Technology Acceptance Model. Overall, our findings suggest that the effectiveness of large-scale digital health investments de- pends critically on citizens’ awareness, trust, and engagement, and that more tailored information campaigns are needed to improve the general literacy of digital tools once they are introduced or potentiated.