An investigation on physicians’ acceptance of hospital information systems: A case study

Factors influencing clinician performance post-electronic health record implementation: an empirical analysis in Moroccan hospitals

BACKGROUND

In recent years, the Moroccan Ministry of Health and Social Protection has invested considerable resources in implementing electronic health record (EHR) systems to provide citizens with quality healthcare services through efficient structures. However, the rhythm of EHR deployment across the country is very slow, requiring urgent evaluation to remove barriers to successful EHR adoption.

OBJECTIVE

This study aims to investigate the critical factors affecting healthcare providers' performance post-EHR implementation in Moroccan public hospitals.

METHODS

A cross-sectional study was conducted in three hospitals affiliated with Hassan II University Hospital Center in Fez. Data were collected using a questionnaire survey administered to a sample of 368 healthcare providers from March 2021 to July 2021. Clinician performance was assessed using a proposed research model that integrates the Information System Success Model and the Technology-Organization-Environment framework. The final model was analyzed and tested by using structural equation modeling. Statistical analyses were conducted using SPSS version 25 and Amos version 26.

RESULTS

The findings highlighted that the most critical factors influencing clinician performance are clinician satisfaction (β = 0.5, p < 0.001), followed by organization (β = 0.28, p < 0.001), and system quality (β = 0.17, p = 0.01). Additionally, information quality indirectly affects clinician performance (β = 0.19, p < 0.001). However, the environmental factor does not appear to have a significant impact (β = -0.004, p = 0.94).

CONCLUSION

This study, performed for the first time in Morocco, identifies key factors for policymakers and healthcare organizations to enhance the successful implementation of EHR systems. Additionally, it serves as a valuable framework for future studies in this area.

Development and validation of an instrument to evaluate the perspective of using the electronic health record in a hospital setting

BACKGROUND

Evaluating healthcare information systems, such as the Electronic Health Records (EHR), is both challenging and essential, especially in resource-limited countries. This study aims to psychometrically develop and validate an instrument (questionnaire) to assess the factors influencing the successful adoption of the EHR system by healthcare professionals in Moroccan university hospitals.

METHODS

The questionnaire validation process occurred in two main stages. Initially, data collected from a pilot sample of 164 participants underwent analysis using exploratory factor analysis (EFA) to evaluate the validity and reliability of the retained factor structure. Subsequently, the validity of the overall measurement model was confirmed using confirmatory factor analysis (CFA) in a sample of 368 healthcare professionals.

RESULTS

The structure of the modified HOT-fit model, comprising seven constructs (System Quality, Information Quality, Information technology Service Quality, User Satisfaction, Organization, Environment, and Clinical Performance), was confirmed through confirmatory factor analysis. Absolute, incremental, and parsimonious fit indices all indicated an appropriate level of acceptability, affirming the robustness of the measurement model. Additionally, the instrument demonstrated adequate reliability and convergent validity, with composite reliability values ranging from 0.75 to 0.89 and average variance extracted (AVE) values ranging from 0.51 to 0.63. Furthermore, the square roots of AVE values exceeded the correlations between different pairs of constructs, and the heterotrait-monotrait ratio of correlations (HTMT) was below 0.85, confirming suitable discriminant validity.

CONCLUSIONS

The resulting instrument, due to its rigorous development and validation process, can serve as a reliable and valid tool for assessing the success of information technologies in similar contexts.

Usability evaluation of emergency information systems in educational hospitals in Kerman, Iran

BACKGROUND

Smart and practical health information systems and applications with fewer errors are crucial for healthcare facilities. One method that ensures the proper design of health information systems (HIS) and applications is usability evaluation.

OBJECTIVE

This study aimed to evaluate the usability of the emergency information systems used at the emergency departments of four educational hospitals in Kerman, Iran.

METHOD

This study was conducted in two phases. In the first phase, the information systems' errors and shortages were identified using a semi-structured questionnaire by users (nurses and the IT staff). In the second phase, based on the results of the first phase, two questionnaires were designed for each group of users to their opinions about the usability of the emergency information systems.

RESULTS

The average score of "reducing and facilitating user's daily activities" was significantly different among hospitals (p = 0.03). Shahid Beheshti Hospital obtained the lowest usability score (17.5), and Afzalipour Hospital received the highest usability score (21.75). Moreover, the average score in "use of the HIS" for nurses and IT staff was 2.93 and 3.54 on a scale of 5, respectively.

CONCLUSION

Usability evaluation of health information systems is essential to ensure that these systems provide sufficient and accurate information and requirements for users and health care providers. Also, modifying health information systems based on the user views and expectations improves the quality of the system and user-system Interaction.

Workflow interruption and nurses' mental workload in electronic health record tasks: An observational study

BACKGROUND

Workflow interruptions are common in modern work systems. Electronic health record (EHR) tasks are typical tasks involving human-machine interactions in nursing care, but few studies have examined interruptions and nurses' mental workload in the tasks. Therefore, this study aims to investigate how frequent interruptions and multilevel factors affect nurses' mental workload and performance in EHR tasks.

METHODS

A prospective observational study was conducted in a tertiary hospital providing specialist and sub-specialist care from June 1^st to October 31^st, 2021. An observer documented nurses' EHR task interruptions, reactions and performance (errors and near errors) during one-shift observation sessions. Questionnaires were administered at the end of the electronic health record task observation to measure nurses' mental workload for the electronic health record tasks, task difficulty, system usability, professional experience, professional competency, and self-efficacy. Path analysis was used to test a hypothetical model.

RESULTS

In 145 shift observations, 2871 interruptions occurred, and the mean task duration was 84.69 (SD 56.68) minutes per shift. The incidence of error or near error was 158, while 68.35% of errors were self-corrected. The total mean mental workload level was 44.57 (SD 14.08). A path analysis model with adequate fit indices is presented. There was a relationship among concurrent multitasking, task switching and task time. Task time, task difficulty and system usability had direct effects on mental workload. Task performance was influenced by mental workload and professional title. Negative affect mediated the path from task performance to mental workload.

CONCLUSIONS

Nursing interruptions occur frequently in EHR tasks, come from different sources and may lead to elevated mental workload and negative outcomes. By exploring the variables related to mental workload and performance, we offer a new perspective on quality improvement strategies. Reducing harmful interruptions to decrease task time can avoid negative outcomes. Training nurses to cope with interruptions and improve competency in EHR implementation and task operation has the potential to decrease nurses' mental workload and improve task performance. Moreover, improving system usability is beneficial to nurses to mitigate mental workload.

Physician engagement strategies in health information system implementations

Health information system implementations are expensive and risky. They have the potential to transform healthcare when implemented successfully. Health leaders need to effectively engage physicians as an important constituent in the project. This can be accomplished by applying user-centred design principles, facilitating physician leadership, and planning for training. When done effectively, a sense of shared ownership and allegiance between management and the physician group is created that will lead to a successful project.

The Reasons for Physicians and Pharmacists' Acceptance of Clinical Support Systems in Saudi Arabia

This research aims to identify the technological and non-technological factors influencing user acceptance of the CDSS in a group of healthcare facilities in Saudi Arabia. The study proposes an integrated model that indicates the factors to be considered when designing and evaluating CDSS. This model is developed by integrating factors from the "Fit between Individuals, Task, and Technology" (FITT) framework into the three domains of the human, organization, and technology-fit (HOT-fit) model. The resulting FITT-HOT-fit integrated model was tested using a quantitative approach to evaluate the currently implemented CDSS as a part of Hospital Information System BESTCare 2.0 in the Saudi Ministry of National Guard Health Affairs. For data collection, a survey questionnaire was conducted at all Ministry of National Guard Health Affairs hospitals. Then, the collected survey data were analyzed using Structural Equation Modeling (SEM). This analysis included measurement instrument reliability, discriminant validity, convergent validity, and hypothesis testing. Moreover, a CDSS usage data sample was extracted from the data warehouse to be analyzed as an additional data source. The results of the hypotheses test show that usability, availability, and medical history accessibility are critical factors influencing user acceptance of CDSS. This study provides prudence about healthcare facilities and their higher management to adopt CDSS.

Dr. Google: Physicians-The Web-Patients Triangle: Digital Skills and Attitudes towards e-Health Solutions among Physicians in South Eastern Poland-A Cross-Sectional Study in a Pre-COVID-19 Era

The investment in digital e-health services is a priority direction in the development of global healthcare systems. While people are increasingly using the Web for health information, it is not entirely clear what physicians' attitudes are towards digital transformation, as well as the acceptance of new technologies in healthcare. The aim of this cross-sectional survey study was to investigate physicians' self-digital skills and their opinions on obtaining online health knowledge by patients, as well as the recognition of physicians' attitudes towards e-health solutions. Principal component analysis (PCA) was performed to emerge the variables from self-designed questionnaire and cross-sectional analysis, comparing descriptive statistics and correlations for dependent variables using the one-way ANOVA (F-test). A total of 307 physicians participated in the study, reported as using the internet mainly several times a day (66.8%). Most participants (70.4%) were familiar with new technologies and rated their e-health literacy high, although 84.0% reported the need for additional training in this field and reported a need to introduce a larger number of subjects shaping digital skills (75.9%). 53.4% of physicians perceived Internet-sourced information as sometimes reliable and, in general, assessed the effects of its use by their patients negatively (41.7%). Digital skills increased significantly with frequency of internet use (F = 13.167; p = 0.0001) and decreased with physicians' age and the need for training. Those who claimed that patients often experienced health benefits from online health showed higher digital skills (-1.06). Physicians most often recommended their patients to obtain laboratory test results online (32.2%) and to arrange medical appointments via the Internet (27.0%). Along with the deterioration of physicians' digital skills, the recommendation of e-health solutions decreased (r = 0.413) and lowered the assessment of e-health solutions for the patient (r = 0.449). Physicians perceive digitization as a sign of the times and frequently use its tools in daily practice. The evaluation of Dr. Google's phenomenon and online health is directly related to their own e-health literacy skills, but there is still a need for practical training to deal with the digital revolution.

Development and Application Evaluation of a Nursing Simulation Teaching Information System Based on Hospital Information Systems

BACKGROUND

The extensive application of hospital information systems in the current information-driven era suggests that nursing education should focus on information education.

METHODS

The newly developed hospital information system was used and evaluated by 544 students to explore the feasibility and necessity of such applications for teaching.

RESULTS

Overall, 97.1% of the students expressed satisfaction, and 96.0% supported simulated information education for nursing. The usability was good, with the system receiving a usability score of 72.625 ± 13.0907. The junior students had a higher score than the sophomores regarding system availability, and the difference was statistically significant.

CONCLUSIONS

Students generally had a high degree of satisfaction with the simulated information nursing education system and highly approved of the teaching method. However, the system needs to be upgraded.

The Role of Personality and Top Management Support in Continuance Intention to Use Electronic Health Record Systems among Nurses

This study examines nurses' Continuance Intention (CI) to use electronic health records (EHRs) through a combination of three conceptual frameworks: the Unified Theory of Acceptance and Use of Technology (UTAUT), the theory of expectation-confirmation (ECT), and the Five-Factor Model (FFM). A model is developed to examine and predict the determinants of nurses' CI to use EHRs, including top management support (TMS) and the FFM's five personality domains. Data were collected from a survey of 497 nurses, which were analyzed using partial least squares. No significant relationship was found between TMS and CI. The study revealed that performance expectancy significantly mediated the influences of two different hypotheses of two predictors: agreeableness and openness to testing CI. A significant moderating impact of conscientiousness was found on the relationship between performance expectancy and CI and the relationship between social influence and CI. The findings of this study indicated that rigorous attention to the personality of individual nurses and substantial TMS could improve nurses' CI to use EHRs. A literature gap was filled concerning the mediating effects of performance expectancy on the FFM-CI relationship, and the moderation effects of Conscientiousness on UTAUT constructs and CI are another addition to the literature. The results are expected to assist government agencies, health policymakers, and health institutions all over the globe in their attempts to understand the post-adoption use of EHRs.

Health Professionals' Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study

Background

Electronic medical records (EMRs) are integrated information sources generated by health care professionals (HCPs) from various health care information systems. EMRs play crucial roles in improving the quality of care and medical decision-making and in facilitating cross-hospital health information exchange. Although many hospitals have invested considerable resources and efforts to develop EMRs for several years, the factors affecting the long-term success of EMRs, particularly in the EMR infusion stage, remain unclear.

Objective

The aim of this study was to investigate the effects of technology, user, and task characteristics on EMR infusion to determine the factors that largely affect EMR infusion. In addition, we examined the effect of EMR infusion on individual HCP performance.

Methods

A questionnaire survey was used to collect data from HCPs with >6 months experience in using EMRs in a Taiwanese teaching hospital. A total of 316 questionnaires were distributed and 211 complete copies were returned, yielding a valid response rate of 66.8%. The collected data were further analyzed using WarpPLS 5.0.

Results

EMR infusion (R²=0.771) was mainly affected by user habits (β=.411), portability (β=.217), personal innovativeness (β=.198), technostress (β=.169), and time criticality (β=.168), and individual performance (R²=0.541) was affected by EMR infusion (β=.735). This finding indicated that user (habit, personal innovativeness, and technostress), technology (portability), and task (mobility and time criticality) characteristics have major effects on EMR infusion. Furthermore, the results indicated that EMR infusion positively affects individual performance.

Conclusions

The factors identified in this study can extend information systems infusion theory and provide useful insights for the further improvement of EMR development in hospitals and by the government, specifically in its infusion stage. In addition, the developed instrument can be used as an assessment tool to identify the key factors for EMR infusion, and to evaluate the extent of EMR infusion and the individual performance of hospitals that have implemented EMR systems. Moreover, the results can help governments to understand the urgent needs of hospitals in implementing EMR systems, provide sufficient resources and support to improve the incentives of EMR development, and develop adequate EMR policies for the meaningful use of electronic health records among hospitals and clinics.

Building Primary Health Care Personnel's Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study

Background

Health care personnel’s (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel’s positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel’s support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals.

Objective

The aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel’s eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP.

Methods

The data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables.

Results

Professionals’ eHealth competence (β=.15, P<.001), usability (β=.11, P<.001), and implementation practices (β=.07, P<.001) were positively associated with professionals’ support and negatively associated with professionals eHealth-related stress (β=−.07, P=.010; β=−.27, P<.001; and β=−.14, P<.001, respectively). Professionals’ support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95% CI 1.07-1.40).

Conclusions

The adoption of appropriate implementation practices and the usability of the technology can build personnel’s support for a patient portal and alleviate their stress related to eHealth. Personnel’s support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals.

Acceptance of clinical decision support systems in Saudi healthcare organisations

Applications of clinical decision support systems (CDSS) have become essential for physicians seeking to make appropriate decisions. The implementation of CDSS, however, is complicated if the factors affecting physician’s acceptance are not recognised. This study aims to explore the various factors that may influence the acceptance of CDSS in Saudi Arabia. A qualitative method was used to collect data from interviews with 54 GPs, with interviews conducted in three stages. The study then integrated the Unified Theory of Acceptance and Use of Technology (UTAUT) and Task-Technology Fit (TTF) models to communicate the findings. It is suggested that all factors of both UTAUT and TTF influence acceptance of CDSS by GPs, with the sole exception of the social influence factor. Some additional factors were also discovered by means of in-depth interviews, including accessibility, patient satisfaction, informativeness (increased knowledge), connectedness (informing patients), communication and shared knowledge, privacy and security, and perceived risk (functional performance risk and time risk). The study thus offers a new insight of the factors influencing GPs’ acceptance of CDSS.

Investigation the success rate of hospital information system (HIS): Development of a questionnaire and case study

INTRODUCTION AND OBJECTIVES

The implantation of hospital information systems (HISs) has grown dramatically in recent years. Understanding the success rate of HIS is key in health organizations. In this study, a validated questionnaire for HISs evaluation based on the Information System Success Model (ISSM) has been provided. In addition, the HIS success rate was determined.

MATERIALS AND METHODS

The current study was conducted at one of the largest teaching hospitals in eastern Iran. The 44-items questionnaire was developed for data gathering. The questionnaire covered ISSM dimensions, which include analysis of quality system, quality of information, quality service, system use, usefulness, satisfaction, and net benefits. Content validity, constructs validity, and reliability of the ISSM questionnaire was measured. HIS success rate has been determined and categorized based on users' perspective as follows: appropriate (75%≤HIS success rate), moderate (50%≤HIS success rate<75%), low coverage (25%≤HIS success rate<50%), and poor (coverage rate<25%).

RESULTS

In total, 253 users participated in the study. The ISSM questionnaire was validated by an expert panel with CVI: 85.12% and CVR: 88.22%. The overall Cronbach's alpha value of the instrument was determined as 92.2%. Nine factors with eigenvalues greater than 1.00 were identified, jointly accounting for 66.91% of the total variance. The value of KMO was.866 showed that the sample size was adequate for factor analysis. The highly significant Bartlett's test (p<0.000) indicated that variables were correlated and the factor analysis was appropriate. Our results demonstrated that the total mean of HIS success was "moderate" base on the users' point of view.

CONCLUSIONS

The findings of the current study, provide valuable scientific evidence for key affecting factors on hospital EHR in Iran as a developing country.

Investigating Evaluation Frameworks for Electronic Health Record: A Literature Review

BACKGROUND: There are various electronic health records (EHRs) evaluation frameworks with multiple dimensions and numerous sets of evaluation measures, while the coverage rate of evaluation measures in a common framework varies in different studies. AIM: This study provides a literature review of the current EHR evaluation frameworks and a model for measuring the coverage rate of evaluation measures in EHR frameworks. METHODS: The current study was a comprehensive literature review and a critical appraisal study. The study was conducted in three phases. In Phase 1, a literature review of EHR evaluation frameworks was conducted. In Phase 2, a three-level hierarchical structure was developed, which includes three aspects, 12 dimensions, and 110 evaluation measures. Subsequently, evaluation measures in the identified studies were categorized based on the hierarchical structure. In Phase 3, relative frequency (RF) of evaluation measures in different dimensions and aspects for each of the identified studies were determined and categorized as follows: Appropriate, moderate, and low coverage. RESULTS: Out of a total of 8276 retrieved articles, 62 studies were considered relevant. The RF range in the second and third level of the hierarchical structure was between 8.6%–91.94% and 0.2%–61%, respectively. “Ease of use” and “system quality” were the most frequent evaluation measure and dimension. Our results indicate that identified studies cover at least one and at most nine evaluation dimensions and current evaluation frameworks focus more on the technology aspect. Almost in all identified studies, evaluation measures related to the technology aspect were covered. However, evaluation measures related to human and organization aspects were covered in 68% and 84% of the identified studies, respectively. CONCLUSION: In this study, we systematically reviewed all literature presenting any type of EHR evaluation framework and analyzed and discussed their aspects and features. We believe that the findings of this study can help researchers to review and adopt the EHR evaluation frameworks for their own particular field of usage.

A case-study to examine doctors’ intentions to use IoT healthcare devices in Iraq during COVID-19 pandemic

Purpose

Several countries have been using internet of things (IoT) devices in the healthcare sector to combat COVID-19. Therefore, this study aims to examine the doctors’ intentions to use IoT healthcare devices in Iraq during the COVID-19 pandemic.

Design/methodology/approach

This study proposed a model based on the integration of the innovation diffusion theory (IDT). This included compatibility, trialability and image and a set of exogenous factors such as computer self-efficacy, privacy and cost into the technology acceptance model comprising perceived ease of use, perceived usefulness, attitude and behavioral intention to use.

Findings

The findings revealed that compatibility and image of the IDT factors, have a significant impact on the perceived ease of use, perceived usefulness and behavioral intention, but trialability has a significant impact on perceived ease of use, perceived usefulness and insignificant impact on behavioral intention. Additionally, external factors such as privacy and cost significantly impacted doctors’ behavioral intention to use. Moreover, doctors’ computer self-efficacy significantly influenced the perceived ease of use, perceived usefulness and behavioral intention to use. Furthermore, perceived ease of use has a significant impact on perceived usefulness and attitude, perceived usefulness has a significant impact on attitude, which, in turn, significantly impacting doctors' behavior toward an intention to use.

Research limitations/implications

The limitations of the present study are the retractions of the number of participants and the lack of qualitative methods.

Originality/value

The finding of this study could benefit researchers, doctors and policymakers in the adaption of IoT technologies in the health sectors, especially in developing counties.

Understanding key factors affecting on hospital electronic health record (EHR) adoption

Introduction:

This study investigated the factors affecting the acceptance of hospital electronic health record (EHR) adoption by users based on Technology Acceptance Model3 (TAM3).

Methods:

The self-administered TAM3 questionnaire was used for data gathering. Content validity and reliability of the TAM3 questionnaire were measured. The relation between dependent, independent, and mediator variables was analyzed using multiple regression analysis.

Results:

The results from 224 users indicated that subjective norm, job relevance, output quality, voluntariness, computer experience have significant impacts on perceived usefulness. Also, perceptions of external control and computer anxiety were identified as having significant impacts on perceived ease of use. Perceived usefulness did not have a mediator role between result demonstrability and behavioral intention. Perceived ease of use was not found to be a mediating factor in the relationship between computer self- efficacy and behavioral intention, as well as perceived enjoyment.

Conclusions:

The findings of the current study, provide valuable scientific evidence for key affecting factors on hospital EHR in Iran as a developing country. Our results showed the main constructs and relationships depicted in the TAM3 were found to be applicable to assess the adoption of hospital EHR.

Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care

BACKGROUND

Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care.

METHODS

The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes.

RESULTS

Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers' workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function.

CONCLUSION

Participants' perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.

Investigating medical professionals' continuance intention of the cloud-based e-learning system: an extension of expectation–confirmation model with flow theory

Purpose

The purpose of this study is to propose an integrated model based on expectation–confirmation model (ECM), flow theory and human–organization–technology fit framework to examine whether human, organizational and technology factors as antecedents to medical professionals' beliefs can affect their continuance intention of the cloud-based e-learning system.

Design/methodology/approach

Sample data for this study were collected from medical professionals at five hospitals in Taiwan. A total of 500 questionnaires were distributed, and 368 (73.6%) useable questionnaires were analyzed using structural equation modeling in this study.

Findings

Synthetically speaking, human, organizational and technology factors, as antecedents to medical professionals' continuance intention of the cloud-based e-learning system have been examined, and the results strongly support the research model with all hypothesized links being significant.

Originality/value

Particularly, it is worth mentioning that the application of capturing both ECM and flow theory for completely explaining three types of factors (i.e. human, organizational and technology factors) as external variables to medical professionals' cloud-based e-learning continuance intention is well documented, that is, information systems (IS) and nonIS determinants are simultaneously evaluated, and extrinsic and intrinsic motivators are both taken into consideration in this study's theoretical development of medical professionals' cloud-based e-learning continuance intention to acquire a more comprehensive and robust analysis.

Attitudes of nurses towards clinical information systems: a systematic review and meta-analysis

AIM

This systematic review and meta-analysis evaluates the attitudes of Iranian nurses towards clinical information systems in nursing practice.

BACKGROUND

Nurses are essential in the successful adoption and implementation of clinical information systems.

METHODS

A systematic search was performed in Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science and Farsi databases, to retrieve relevant studies. The methodological quality of the studies is assessed via the Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies. The random effect model was utilized to analyse the data due to the high heterogeneity in the included studies (n = 17).

RESULTS

Results indicate that clinical information systems impact on at least seven aspects of nursing practice, including documentation, patient safety, quality of treatment, communication, treatment management, nursing tasks and hospital resource management. Results also indicated that one aspect of using clinical information systems in nursing practice is satisfaction with the 'quality and design of clinical information systems', such as ease of use and learning, flexibility and software speed.

CONCLUSION

Clinical information systems can contribute to different aspects of nursing practice. However, their design should improve significantly in order to help nurses perform their professional activities in an efficient and satisfactory manner.

IMPLICATIONS FOR NURSING POLICY

Before the full deployment of clinical information systems, their usability should be tested. In pilot testing, nurses should provide necessary feedback about how well the systems work and improvements needed to meet their professional goals.

Quality antecedents and performance outcome of cloud-based hospital information system continuance intention

Purpose

This study's purpose is to propose an integrated model based on expectation-confirmation model (ECM), task-technology fit (TTF) model, and updated DeLone and McLean information system (IS) success model to examine whether quality factors and TTF as antecedents to physician beliefs can affect physicians' continuance intention of the cloud-based hospital information system (HIS) and performance impact.

Design/methodology/approach

Sample data for this study were collected from physicians at five hospitals in Taiwan. A total of 500 questionnaires were distributed, and 305 (61.0 percent) usable questionnaires were analyzed using structural equation modeling in this study.

Findings

This study verified that physicians' perceived information quality, system quality, general technical support service quality, and cloud storage service quality all positively caused their PU, confirmation, and perceived TTF in the cloud-based HIS, which together explained their satisfaction with the system, and subsequently led to their continuance intention of the system and performance impact.

Originality/value

First, IS-related and cloud-related quality factors are simultaneously taken into consideration within this study's research model, and empirical results reveal deep insights into quality evaluation in the field of physicians' cloud-based HIS continuance intention. Next, this study contributes to an understanding of TTF in explaining physicians' cloud-based HIS continuance intention that is difficult to explain with only their utilitarian perception of the system, and places emphasis upon physicians' perception of performance impact greatly driven by their perceived TTF and continuance intention of the system, thus the results can shed light on antecedents and outcome of physicians' cloud-based HIS continuance intention.

Predictive factors of physicians’ satisfaction with telemedicine services acceptance

Despite the significant increase in telemedicine services technology, its adoption and use have been quite slow in some healthcare settings. It is generally accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying physicians and patients is one of the crucial objectives of telemedicine success. This study seeks to evaluate physicians’ satisfaction with telemedicine services adoption and utilization using the technology acceptance model. A structured questionnaire based on the construct of technology acceptance model was used to solicit for data from participants in four different government health institutions. Purposive and convenience sampling techniques were employed to select healthcare professionals from various medical fields. Structural equation modeling was utilized in the data analysis. Perceived ease of use and perceived usefulness of telemedicine services were found to influence physicians’ behavioral intentions. This resulted in increased efficiency, quality of services, quality patient care delivery, and satisfaction among physicians in using telemedicine services. We noted that the adoption of telemedicine services in clinical settings depends on physicians’ and patients’ satisfaction with the use of the service. The study contributes to empirical knowledge by identifying the vital predictive factors affecting telemedicine services satisfaction among physicians.

"Assessment of the social influence and facilitating conditions that support nurses' adoption of hospital electronic information management systems (HEIMS) in Ghana using the unified theory of acceptance and use of technology (UTAUT) model"

Background

Hospital electronic information management systems (HEIMS) are widely used in Ghana, and hence its performance must be carefully assessed. Nurses as clinical health personnel are the largest cluster of hospital staff and are the pillar of healthcare delivery. Therefore, they play a crucial role in the adoption and assessment of HEIMSs in Ghana. This report sought to assess the “Social Influence” (SI) and “Facilitating Conditions” (FC) that support Nurses’ Acceptance of HEIMS in Ghana using the “Unified Theory of Acceptance and Use of Technology” (UTAUT) model.

Methods

This study applied a non-experimental survey design. An electronic platform questionnaire on smartphones was used to collect data on 660 nurses. Statistically, AMOS Structural Equation Modelling (SEM) version 22.0 was employed to examine the research model.

Results

“Behavioral Intention” (BI) to HEIMS use was significantly predicted by SI and FC (p < 0.001). Notably, both SI and FC had an influence on nurses’ use behavior (UB) with behavioral intention (BI) as the mediator, which explains a total of 42.1% variance in the intention of nurses to use HEIMS. Likewise, UB of HEIMS was also significantly predicted by SI (R² = 43.2) and BI (R² = 0.39.6) with both constructs explaining a total of 51.7% of the variance in nurses’ acceptance to use HEIMS.

Conclusion

Nurses’ adoption of HEIMS in terms of the UB was influenced by SI and BI, whiles SI and FC had the strongest influence on BI (serving as mediator) of UB to adopt and use HEIMS among the nurses in Ghanaian hospitals.

Factors Affecting Acceptance of Hospital Information Systems in Public Hospitals of Zahedan University of Medical Sciences: A Cross-Sectional Study

A hospital information system is used to support a wide range of operations and activities in the hospital. This study was conducted to determine the factors affecting hospital information system acceptance by users. A cross-sectional, descriptive, analytic study was performed in 2018. The study population included 550 users of the system. The data were collected using a questionnaire and analyzed using the SPSS software. A significant moderate positive correlation was found between hospital information system acceptance and perceived usefulness (r = 0.54, P < 0.01), perceived ease of use (r = 0.41, P < 0.01), human factors (r = 0.46, P < 0.01) and technological factors (r = 0.54, P < 0.01). A significant weak positive correlation was detected between the acceptance of the hospital information system and organizational factors (r = 0.35, P < 0.01). Perceived usefulness of the system, social influence, system quality, perceived ease of use of the system, and top managers' supports had the most substantial influence on the users' intention to accept a hospital information system. User education, preparation of guidelines suited to the user specialty or department, incorporating users' work needs into the capabilities of the hospital information system, and improving the system to an ideal level are important considerations.

External validation of the unified model of information systems continuance (UMISC): An international comparison

CONTEXT

The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP.

OBJECTIVE

The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ.

METHODS

The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM).

RESULTS

A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites.

CONCLUSION

The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.

Development and initial psychometric evaluation of the computer-based prostate Cancer screening decision aid acceptance scale for African-American men

BACKGROUND

To reliably evaluate the acceptance and use of computer-based prostate cancer decision aids (CBDAs) for African-American men, culturally relevant measures are needed. This study describes the development and initial psychometric evaluation of the 24-item Computer-Based Prostate Cancer Screening Decision Aid Acceptance Scale among 357 African-American men.

METHODS

Exploratory factor analysis (EFA) with maximum likelihood estimation and polychoric correlations followed by Promax and Varimax rotations.

RESULTS

EFA yielded three factors: Technology Use Expectancy and Intention (16 items), Technology Use Anxiety (5 items), and Technology Use Self-Efficacy (3 items) with good to excellent internal consistency reliability at .95, .90, and .85, respectively. The standardized root mean square residual (0.035) indicated the factor structure explained most of the correlations.

CONCLUSIONS

Findings suggest the three-factor, 24-item Computer-Based Prostate Cancer Screening Decision Aid Acceptance Scale has utility in determining the acceptance and use of CBDAs among African-American men at risk for prostate cancer. Future research is needed to confirm this factor structure among socio-demographically diverse African-Americans.

Theoretical integration of user satisfaction and technology acceptance of the nursing process information system

Background

The nursing process system (NPS) is used to establish the nursing process involving assessment, diagnosis, planning, intervention, and evaluation in solving the health problems of patients.

Objectives

The factors influencing the use of the NPS by nurses were analyzed based on user satisfaction and technology acceptance within the 3Q (service quality, information quality, and system quality) model.

Methods

In this cross-sectional quantitative study, the valid responses of 222 nurses to a questionnaire were obtained; these nurses worked at eight hospitals affiliated with public organizations in Taiwan. Structural equation modeling was used to analyze information quality, system quality, service quality, user satisfaction, perceived usefulness, perceived ease of use, perceived enjoyment, behavioral attitude, and intention after the nurses had used the NPS system for more than 1 month.

Results

Information quality, service quality, and system quality influenced user satisfaction. User satisfaction affected perceived usefulness, perceived ease of use, and perceived enjoyment and had the highest explanatory power (R² = 0.75). Furthermore, perceived usefulness, perceived ease of use, and perceived enjoyment influenced behavioral attitude and intention to use the system. The proposed model explained 53% of the variance in the intention to use the NPS.

Conclusions

The relationships between the variables of the 3Q model were successfully used to examine the intention of nurses toward using the NPS. Using the findings of this study, designers and programmers can comprehensively understand the perceptions of nurses and further improve the performance of the NPS.

Determining the Hospital Information System (HIS) Success Rate: Development of a New Instrument and Case Study

BACKGROUND:

Hospital Information System (HIS) is a type of health information system which is widely used in clinical settings. Determining the success rate of HISs is an ongoing area of research since its implications are of interest for researchers, physicians and managers.

AIM:

In the present study, we develop a novel instrument to measure HIS success rate based on users’ viewpoints in a teaching hospital.

METHODS:

The study was conducted in Ebnesina and Dr Hejazi Psychiatric Hospital and education centre in Mashhad, Iran. The instrument for data collection was a self-administered structured questionnaire based on ISSM, covering seven dimensions, which includes system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits. The verification of content validity was carried out by an expert panel. The internal consistency of dimensions was measured by Cronbach’s alpha. Pearson’s correlation coefficient was calculated to evaluate the significance of associations between dimensions. The HIS success rate on users’ viewpoints was determined.

RESULTS:

A total of 125 users participated in the study. The instrument was validated by an expert panel with the Content Validity Index (CVI): 0.85 and Content Validity Ratio (CVR): 0.86. The overall Cronbach’s alpha value of the instrument was 0.93. The Pearson correlation coefficient showed significant positive relationships among the investigated dimensions. On average, HIS success rate in the hospital under study was 65% (CI: 64%, 67%). The dimensions of “usefulness”, “system quality”, and “net benefits” showed the highest rates of success, respectively.

CONCLUSION:

The instrument used in this study can be adopted for HIS evaluation in future studies. In the current study, a method was developed to determine the HIS success rate based on users’ viewpoints. This method allows for the comparison of HIS success rates in various hospitals. As well, our findings underscore the viewpoints of HIS users in a developing country.’

The Role of Frontline Leaders in Building Health Professional Support for a New Patient Portal: Survey Study

Background

Effective leadership and change management are thought to contribute to the successful implementation of health information technology innovations. However, limited attention has been paid to the role of frontline leaders in building health professional support for new technical innovations.

Objective

First, we examined whether frontline leaders’ positive expectations of a patient portal and perceptions of its implementation were associated with their support for the portal. Second, we explored whether leaders’ positive perceptions influenced the same unit’s health professional support for the portal.

Methods

Data were collected through an online survey of 2067 health professionals and 401 frontline leaders working in 44 units from 14 health organizations in Finland. The participating organizations run a joint self-care and digital value services project developing a new patient portal for self-management. The survey was conducted before the piloting and implementation of the patient portal.

Results

The frontline leaders’ perception of vision clarity had the strongest association with their own support for the portal (ß=.40, P<.001). Results also showed an association between leaders’ view of organizational readiness and their support (ß=.15, P=.04). The leaders’ positive perceptions of the quality of informing about the patient portal was associated with both leaders’ own (ß=.16, P=.02) and subordinate health professionals’ support for the portal (ß=.08, P<.001). Furthermore, professional participation in the planning of the portal was positively associated with their support (ß=.57, P<.001).

Conclusions

Findings suggest that assuring good informing, communicating a clear vision to frontline leaders, and acknowledging organizational readiness for change can increase health professional support for electronic health (eHealth) services in the pre-implementation phase. Results highlight the role of frontline leaders in engaging professionals in the planning and implementation of eHealth services and in building health professionals’ positive attitudes toward the implementation of eHealth services.

Understanding Determinants of Health Care Professionals' Perspectives on Mobile Health Continuance and Performance

BACKGROUND

With the widespread use of mobile technologies, mobile information systems have become crucial tools in health care operations. Although the appropriate use of mobile health (mHealth) may result in major advances in expanding health care coverage (increasing decision-making speeds, managing chronic conditions, and providing suitable health care in emergencies), previous studies have argued that current mHealth research does not adequately evaluate mHealth interventions, and it does not provide sufficient evidence regarding the effects on health.

OBJECTIVE

The aim of this study was to facilitate the widespread use of mHealth systems; an accurate evaluation of the systems from the users' perspective is essential after the implementation and use of the system in daily health care practices. This study extends the expectation-confirmation model by using characteristics of individuals, technology, and tasks to identify critical factors affecting mHealth continuance and performance from the perspective of health care professionals (HCPs).

METHODS

A questionnaire survey was used to collect data from HCPs who were experienced in using mHealth systems of a Taiwanese teaching hospital. In total, 282 questionnaires were distributed, and 201 complete and valid questionnaires were returned, thus indicating a valid response rate of 71.3% (201/282). The collected data were analyzed using WarpPLS version 5.0 (ScriptWarp Systems).

RESULTS

The results revealed that mHealth continuance (R²=0.522) was mainly affected by perceived usefulness, technology maturity, individual habits, task mobility, and user satisfaction, whereas individual performance (R²=0.492) was affected by mHealth continuance. In addition, user satisfaction (R²=0.548) was affected by confirmation and perceived usefulness of mHealth, whereas perceived usefulness (R²=0.521) was affected by confirmation. This implied that confirmation played a key role in affecting perceived usefulness and user satisfaction. Furthermore, the results showed that mHealth continuance positively affected individual performance.

CONCLUSIONS

The identified critical factors influencing mHealth continuance and performance can be used as a useful assessment tool by hospitals that have implemented mHealth systems to facilitate the use and infusion of the systems. Furthermore, the results can help health care institutions that intend to introduce or develop mHealth applications to identify critical issues and effectively allocate limited resources to mHealth systems.

Investigation of Resistance, Perception and Attitudes of Employees against Change in Information Systems Using Change Management Approach: A Study in a University Hospital

The need for change in the rapidly developing health sector is essential for the provision of quality health care services. In this study, the technological change experienced in the process of transition from the old hospital information management system used in a university hospital to the new hospital information management system was discussed and employees’ resistance, perceptions and attitudes to change have been examined through a change management approach. In this study, we aimed to examine the level of usage of the change management tools and change management phases in a university hospital through a change management approach in the transition phase to the new HIS. We also aim to discuss faced problems encountered in the change process, help to create consciousness for management of change, examine behavioural reasons of resistance of healthcare professionals and present our experiences and propose solutions in the view of adoption and acceptance management tools against change in Hospital Information Systems (HIS) for healthcare managers. In the research, it has been observed that in the transition to the new information system, the change management tools are applied partially whereas change management phases have been implemented to a large extent. University hospital employees are resistant to Hospital Information Management System replacement. The most resistant groups are doctors and nurses and the least resistant employees are administrative staff. The rise in hospital revenues following the change is noteworthy.

Designing a model of hospital information system acceptance: Organizational culture approach

Background: The significance and influence of organizational culture on Information Technology acceptance, especially in healthcare field, has been recognized as a source of organizational inertia. This study aimed at developing a model of Hospital Information System (HIS) acceptance for non-teaching hospitals of Iran University of Medical Sciences to encourage the authorities to promote organizational culture and successful application of HIS.

Methods: The proposed model was developed according to Michigan Organizational Assessment Questionnaire (MOAQ), Harrison, Hofstede models, and Comparative Values Framework (CVF). The questionnaires were designed based on the model and distributed among 400 HIS users in the hospitals under study, who were selected using stratified random sampling. The structural equation modeling method was used for data analysis in LISREL software.

Results: According to the final model, the influences of developmental culture on perceived usefulness, the relationship of 4 types of organizational culture with mandatoriness according to CVF, and the relationships of hierarchical and developmental culture with system use were attested. The relationships between supervision and 4 variables of HIS acceptance were confirmed. Furthermore, the influence of process/ result oriented culture on user satisfaction was demonstrated. The normed chi square index (2.60) revealed that the final model was fitted to the data. The indices were as follow: GFI= 0.95, CFI= 0.97, AGFI= 0.88, RMSEA= 0.064.

Conclusion: The components and structural relationships in the model of this study are applicable in the related hospitals, and using this model can promote organizational culture and acceptance of HIS by the users.

A novel mixed sustainability-resilience framework for evaluating hospital information systems

Information systems (ISs) are one of the most widely used systems in different organizations especially hospitals. Improving the performance of a hospital information system (HIS) is one of the most important tasks for patient satisfaction and health. To do this, a mixed sustainability-resilience framework for evaluating HISs is proposed in this study in order to enhance their performance from a mixed sustainability-resilience view. First, a comprehensive framework including suitable sustainable and resilience indicators for performance enhancement of HISs is provided. Then, the importance weight of each indicator is achieved by using the best-worst method (BWM). Required data is obtained through a standard questionnaire. A data envelopment analysis (DEA) is applied to evaluate HIS performance in different departments of a real case study. Additionally, improvement actions are obtained by considering the effect of each selected indicator on the HIS performance through a sensitivity analysis. Also, appropriate strategies for improving the resilience and sustainability aspects of the HIS are presented using strengths-weaknesses-opportunities-threats (SWOT) matrix. Using the results, designers can build more intelligent HISs from both sustainability and resilience perspectives.

Evaluation of the unified model of information systems continuance (UMISC) in two hospital environments

CONTEXT

The deployment and long-term acceptance of clinical information systems (CISs) are faced with multiple difficulties. They include insufficient quality of the systems in place and resistance to the multiple changes they induce in care processes. Permanent evaluation of deployed solutions is a prerequisite to their continuous improvement.

OBJECTIVE

The purpose of this study was twofold: (1) To validate the post-adoption unified model of information systems continuance (UMISC) progressively developed at the Georges Pompidou University Hospital (HEGP) in Paris (internal validation); and (2) To compare, using the same evaluation model, the results observed at HEGP with those of the Saint-Joseph Hospital Group (HPSJ), another Paris acute care institution (external validation).

METHODS

The UMISC post-adoption model is built around nine dimensions: end-user characteristics, social norm (SN), IS quality (ISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), profession-adjusted use (PAU), satisfaction (SAT), and continuance intention (CI). Two semi-quantitative evaluation surveys were performed at HEGP in 2014 and 2015, and one at HPSJ in 2015. Statistical analysis included multiple regression analysis and structural equation modeling (SEM).

RESULTS

The analysis concerned 459 responders, 264 at HEGP and 195 at HPSJ. UMISC indicators, with the exception of SN, are superior at HEGP than at HPSJ, which had a shorter CIS anteriority than HEGP. In SEM analysis, the UMISC model explained 25% and 40% of the CIS use, 92% and 93% of health professionals' satisfaction, and 72% and 71% of continuance intention at HEGP and HPSJ, respectively. Seventeen of the 21 tested UMISC hypotheses were supported in at least one of the two sites.

CONCLUSION

The UMISC evaluation model can be used as a comparison and explanatory model of CIS use, satisfaction and continuance intention in post-CIS adoption situations that become prevalent in current electronic hospitals.

The intention to use an electronic health record and its antecedents among three different categories of clinical staff

Background

Like other sectors, the healthcare sector has to deal with the issue of users’ acceptance of IT. In healthcare, different factors affecting healthcare professionals’ acceptance of software applications have been investigated. Unfortunately, inconsistent results have been found, maybe because the different studies focused on different IT and occupational groups. Consequently, more studies are needed to investigate these implications for recent technology, such as Electronic Health Records (EHR).

Methods

Given these findings in the existing literature, we pose the following research question: “To what extent do the different categories of clinical staff (physicians, paraprofessionals and administrative personnel) influence the intention to use an EHR and its antecedents?” To answer this research question we develop a research model that we empirically tested via a survey, including the following variables: intention to use, ease of use, usefulness, anxiety, self-efficacy, trust, misfit and data security. Our purpose is to clarify the possible differences existing between different staff categories.

Results

For the entire personnel, all the hypotheses are confirmed: anxiety, self-efficacy, trust influence ease of use; ease of use, misfit, self-efficacy, data security impact usefulness; usefulness and ease of use contribute to intention to use the EHR. They are also all confirmed for physicians, residents, carers and nurses but not for secretaries and assistants. Secretaries’ and assistants’ perception of the ease of use of EHR does not influence their intention to use it and they could not be influenced by self-efficacy in the development of their perception of the ease of use of EHR.

Conclusions

These results may be explained by the fact that secretaries, unlike physicians and nurses, have to follow rules and procedures for their work, including working with EHR. They have less professional autonomy than healthcare professionals and no medical responsibility. This result is also in line with previous literature highlighting that administrators are more motivated by the use of IT in healthcare.

User acceptance factors of hospital information systems and related technologies: Systematic review

This study reviews the literature on the most important acceptance factors associated with Hospital Information Systems (HIS) and related technologies based on user groups' perspectives (medical staff, hospital management, administrative personnel, patient, medical student, and IT staff), which can assist researchers and hospital management to develop suitable acceptance models to improve the quality of HIS. We conducted searches in online databases with large repositories of academic studies, written in English and fully accessible by the authors. The articles being reviewed are related to health information technology (HIT), clinical information systems (CIS), HIS, electronic medical records (EMR), telemedicine or telehealth, picture archiving and communication systems (PACS), radio frequency identification (RFID), and computerized physician order entry (CPOE), where the use of most of those applications and technologies is highly integrated. A predefined string was used to extract 1,005 articles, and the results were reviewed and checked. The results of this study found 15 user acceptance factors related to HIS and related technologies that were frequently identified by a minimum of five previous studies. These factors were related to individual, technological, and organizational factors. In addition, HIS and related technologies' user acceptance factors in each user group describe different results.

Technology meets tradition: The perceived impact of the introduction of information and communication technology on ward rounds in the intensive care unit

BACKGROUND

Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not).

METHODS

The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis.

RESULTS

The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters.

CONCLUSION

ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a social problem. However, there are significant opportunities to ensure that new technologies do not obstruct doctors' roles as carers nor disrupt the embodied relationship they need to have with patients.

Acceptance model of a Hospital Information System

PURPOSE

The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance.

METHOD

This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0.

RESULTS

The study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users' opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals.

CONCLUSIONS

Based on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS.

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon

Background

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools.

Methods

A self-administered questionnaire was used to assess participants’ socio-demographics, computer use, literacy, and access, and participants’ readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane’s T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth.

Results

Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants’ level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy.

Conclusion

The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

Consumer choice of on-demand mHealth app services: Context and contents values using structural equation modeling

OBJECTIVE

As smartphone penetration increases and the technology advances, various mobile services have reached the market. mHealth Applications are specifically highlighted for phenomena such as global aging & well-being, but the technology-driven mHealth services have not been successful in the market because consumer needs have not been reflected in the services properly. This study developed a research model consisting of context/contents values to explain the intention of consumers over the age of 40 in using mHealth Applications.

METHOD

To carry out this research, an online survey was conducted of mHealth Application users and recognizers in South Korea who are over 40 years old. 313 respondents gave usable data; those data were analyzed via a structural equation model.

RESULTS

Context values (health stress, epistemic) produce an effect on contents values and contents values (convenience, usefulness), excepting reassurance and enjoyment, positively affect the intention to use mHealth Applications. The findings indicate that people who are stressed out about their health and are interested in new ways to control their health think that mHealth Applications are very convenient and useful because people can manage their health at home or at the office, even when they cannot go to a hospital. However, they feel that the current level of service does not provide reassurance. The level of service is behind people's expectations. Hence, a market-oriented approach that can determine user needs, specifically in terms of the reassurance value in the mHealth service field, is needed to develop mHealth Applications.

Adoption of e-health technology by physicians: a scoping review

OBJECTIVE

The goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians.

DESIGN

Scoping review.

SETTING

MEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians.

RESULTS

Full-text screening yielded 74 studies to be included in the scoping review. Within those studies, eleven themes were identified, including cost and liability issues, unwillingness to use e-health technology, and training and support.

CONCLUSION

Cost and liability issues, unwillingness to use e-health technology, and training and support were the most frequently mentioned barriers and facilitators to the adoption of e-health technology. Government-level payment incentives and privacy laws to protect health information may be the key to overcome cost and liability issues. The adoption of e-health technology may be facilitated by tailoring to the individual physician's knowledge of the e-health technology and the use of follow-up sessions for physicians and on-site experts to support their use of the e-health technology. To ensure the effective uptake of e-health technologies, physician perspectives need to be considered in creating an environment that enables the adoption of e-health strategies.

Physicians' perspectives of adopting computer-assisted navigation in orthopedic surgery

OBJECTIVES

Using Computer-assisted orthopedic navigation surgery system (CAOS) has many advantages but is not mandatory to use during an orthopedic surgery. Therefore, opinions obtained from clinical orthopedists with this system are valuable. This paper integrates technology acceptance model and theory of planned behavior to examine the determinants of continued CAOS use to facilitate user management.

METHODS

Opinions from orthopedists who had used a CAOS for at least two years were collected through a cross-sectional survey to verify the research framework. Follow-up interviews with an expert panel based on their experiences of CAOS were conducted to reason the impacts of factors of the research framework.

RESULTS

The results show that factors of "perceived usefulness" and "facilitating condition" determine the intention to continue using CAOS, and "perceived usefulness" was driving by "complexity of task" and "social influence". Additionally, support in practice from high-level managers had an influence on orthopedists' satisfaction after using a CAOS.

CONCLUSIONS

The aging population is accompanied by the increasing requirements for medical care and medical care attendant expenses, especially in total knee replacement. More precision and improvements on survivorship of patients' artificial joints are needed. This study facilitates suggestions in user management when encountering an obstacle in implementing a CAOS. Based on these findings, scientific and practical implications are then discussed.