# From pilot to policy: Adoption of the National mHealth application EZKarta in Czechia

## TL;DR

This study explores why the Czech mHealth app EZKarta failed to gain widespread use during its pilot phase, highlighting issues like poor usability and lack of integration with healthcare systems.

## Contribution

The study provides novel insights into the institutional and user-level barriers to mHealth adoption in transitional health systems like Czechia.

## Key findings

- The EZKarta app had a usability score significantly below international benchmarks.
- Most users were dissatisfied and saw little added value in the app.
- Stakeholders identified fragmented governance and poor integration as major barriers to adoption.

## Abstract

Mobile health (mHealth) applications are increasingly seen as essential components of healthcare digitalization, yet many national initiatives struggle to progress beyond pilot phases. In Czechia, the EZKarta mobile application was launched by the Ministry of Health as a secure digital gateway to vaccination records and preventive check-ups, marking a first step toward a national eHealth platform.

This study provides an exploratory, analytically grounded insight into early user perceptions and stakeholder views on EZKarta during its pilot phase, focusing on institutional, governance, and user-level factors influencing sustainability and integration.

A mixed-methods design was applied. Quantitative data from a national online survey (n = 209) were analyzed using nonparametric tests. The qualitative component included semistructured interviews with key stakeholders. Findings were integrated through joint interpretation and thematic triangulation.

The mean usability score (UMUX = 33.2 ± 6.5) was significantly below the international benchmark (p < 2.2 × 10−16). Only 38% of users reported satisfaction, while 72% indicated willingness to use the application if integrated with their provider's clinical system. Triangulation of survey and interview data suggests that low engagement was driven primarily by limited functionality, lack of clinical system integration, and unclear perceived added value. Stakeholders highlighted fragmented governance as key barriers, while recognizing EZKarta's potential role in national digital health coordination.

EZKarta exemplifies both the opportunities and constraints of mHealth adoption in transitional health systems. Stronger institutional coordination and transparent communication are essential for long-term relevance. The findings may inform policymakers in Central and Eastern Europe.