Examining the acceptance of an integrated Electronic Health Records system: Insights from a repeated cross-sectional design

Understanding the predictors of health professionals' intention to use electronic health record system: extend and apply UTAUT3 model

BACKGROUND

The implementation of Electronic Health Record (EHR) systems is a critical challenge, particularly in low-income countries, where behavioral intention plays a crucial role. To address this issue, we conducted a study to extend and apply the Unified Theory of Acceptance and Use of Technology 3 (UTAUT3) model in predicting health professionals' behavioral intention to use EHR systems.

METHODS

A quantitative research approach was employed among 423 health professionals in Southwest Ethiopia. We assessed the validity of the proposed model through measurement and structural model statistics. Analysis was done using SPSS AMOS version 23. Hypotheses were tested using structural equation modeling (SEM) analysis, and mediation and moderation effects were evaluated. The associations between exogenous and endogenous variables were examined using standardized regression coefficients (β), 95% confidence intervals, and p-values, with a significance level of p-value < 0.05.

RESULTS

The proposed model outperformed previous UTAUT models, explaining 84.5% (squared multiple correlations (R2) = 0.845) of the variance in behavioral intention to use EHR systems. Personal innovativeness (β = 0.215, p-value < 0.018), performance expectancy (β = 0.245, p-value < 0.001), and attitude (β = 0.611, p-value < 0.001) showed significant associations to use EHR systems. Mediation analysis revealed that performance expectancy, hedonic motivation, and technology anxiety had significant indirect effects on behavioral intention. Furthermore, moderation analysis indicated that gender moderated the association between social influence, personal innovativeness, and behavioral intention.

CONCLUSION

The extended UTAUT3 model accurately predicts health professionals' intention to use EHR systems and provides a valuable framework for understanding technology acceptance in healthcare. We recommend that digital health implementers and concerned bodies consider the comprehensive range of direct, indirect, and moderating effects. By addressing personal innovativeness, performance expectancy, attitude, hedonic motivation, technology anxiety, and the gender-specific impact of social influence, interventions can effectively enhance behavioral intention toward EHR systems. It is crucial to design gender-specific interventions that address the differences in social influence and personal innovativeness between males and females.

The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis

BACKGROUND

The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.

OBJECTIVE

This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.

RESULTS

A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.

CONCLUSIONS

Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.

Investigating allied health professionals' attitudes, perceptions and acceptance of an electronic medical record using the Unified Theory of Acceptance and Use of Technology

Objective This study aimed to investigate allied health professionals' (AHPs') perspectives pre- and post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods Data were collected pre- and post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann-Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption.

Acceptance of a Text Messaging Vaccination Reminder and Recall System in Malaysia's Healthcare Sector: Extending the Technology Acceptance Model

Malaysian healthcare institutions still use ineffective paper-based vaccination systems to manage childhood immunization schedules. This may lead to missed appointments, incomplete vaccinations, and outbreaks of preventable diseases among infants. To address this issue, a text messaging vaccination reminder and recall system named Virtual Health Connect (VHC) was studied. VHC simplifies and accelerates immunization administration for nurses, which may result in improving the completion and timeliness of immunizations among infants. Considering the limited research on the acceptance of these systems in the healthcare sector, we examined the factors influencing nurses' attitudes and intentions to use VHC using the extended technology acceptance model (TAM). The novelty of the conceptual model is the incorporation of new predictors of attitude, namely, perceived compatibility and perceived privacy and security issues. We conducted a survey among 121 nurses in Malaysian government hospitals and clinics to test the model. We analyzed the collected data using partial least squares structural equation modeling (PLS-SEM) to examine the significant factors influencing nurses' attitudes and intentions to use VHC. Moreover, we applied an artificial neural network (ANN) to determine the most significant factors of acceptance with higher accuracy. Therefore, we could offer more accurate insights to decision-makers in the healthcare sector for the advancement of health services. Our results highlighted that the compatibility of VHC with the current work setting of nurses developed their positive perspectives on the system. Moreover, the nurses felt optimistic about the system when they considered it useful and easy to use in the workplace. Finally, their attitude toward using VHC played a pivotal role in increasing their intention to use it. Based on the ANN models, we also found that perceived compatibility was the most significant factor influencing nurses' attitudes towards using VHC, followed by perceived ease of use and perceived usefulness.

Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients

BACKGROUND

Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment.

OBJECTIVE

The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation.

DESIGN

Semi-structured qualitative interviews were conducted with 27 patients.

PARTICIPANTS

Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic.

APPROACH

A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology.

KEY RESULTS

Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE.

CONCLUSION(S)

Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.

Neurological Outpatients Prefer EEG Home-Monitoring over Inpatient Monitoring-An Analysis Based on the UTAUT Model

Home monitoring examinations offer diagnostic and economic advantages compared to inpatient monitoring. In addition, these technical solutions support the preservation of health care in rural areas in the absence of local care providers. The acceptance of patients is crucial for the implementation of home monitoring concepts. The present research assesses the preference for a health service that is to be introduced, namely an EEG home-monitoring of neurological outpatients-using a mobile, dry-electrode EEG (electroencephalography) system-in comparison to the traditional long-time EEG examination in a hospital. Results of a representative study for Germany (n = 421) reveal a preference for home monitoring. Importantly, this preference is partially driven by a video explaining the home monitoring system. We subsequently analyzed factors that influence the behavioral intention (BI) to use the new EEG system, drawing on an extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. The strongest positive predictor of BI is the belief that EEG home-monitoring will improve health quality, while computer anxiety and effort expectancy represent the strongest barriers. Furthermore, we find the UTAUT model's behavioral intention construct to predict the patients' decision for or against home monitoring more strongly than any other patient's characteristic such as gender, health condition, or age, underlying the model's usefulness.

The Acceptance and Use of Electronic Medical Records in Developing Countries within the Unified Theory of Acceptance and Use of Technology Framework

BACKGROUND: The Indonesian Ministry of Health requires hospitals to record and report all activities in the Hospital Management Information System (SIMRS). However, the disruptive use of software, hardware, and Brainware has reduced its effective management and usability, which has become a separate workload. Electronic Medical Record (EMR) is one of the important implementations of SIMRS because it relates to the ability to identify information, results, history taking, examinations, and records of all patients. Furthermore, it has become a current global trend for most hospitals and has also been used as a substitute for paper medical records. AIM: This study aims to collect and identify the user characteristic, technology used, and other variables influencing the acceptance and use of information and technology systems based on the unified theory of acceptance and use of technology (UTAUT) model. METHOD: Secondary data were obtained from scientifically published journals online in the form of original articles that are accessed in full text with the help of search engines such as Springer link, Proquest, PubMed, and Prospero. RESULT: It was found that the most dominant technology system in hospitals outside the use of HIS, Electronic Health Record (EHR), physician assistants, E-Prescribing, Telemedicine, extended producer responsibility, and Technology solution for tuberculosis was EMR. It had the largest influence variable in several studies based on the UTAUT model. The most dominant characteristics of users were women between the ages of 20 and 30 years with 0 and 5 years working experience, and also 60% were nurses. The result also showed that 17 other variables had influenced the use of information and technology systems in the UTAUT model. Conclusion: Literature study provides evidence that acceptance and use of health information technology systems, especially RME in hospitals influenced by the main variable UTAUT. Variables related to technical aspects, behavior, and user characteristics as new endogenous and new exogenous mechanisms. Management of health service providers in increasing acceptance and use of EMR needs to pay attention to the availability of infrastructure, user factors are also an important concern in helping to deal with problems in developing countries.