Acceptance and use of electronic medical records: An exploratory study of hospital physicians’ salient beliefs about HIT systems

Introducing Computerized Technology to Nurses: A Model Based on Cognitive Instrumental and Social Influence Processes

The use of computerized technologies as an integral part of nursing has become a reality in the health care system. Studies present different approaches that range from accepting technology as a health promoter to an approach that opposes computerization. This study, which examined social and instrumental processes that influence nurses' attitudes toward computer technology, will present a model for the optimal assimilation of computer technology in the nurses' work environment. The study, which included 224 participants, was designed as a mixed method and included questionnaires and semi-structured interviews of participants. The data were analyzed to understand the factors that influenced nurses' attitudes toward the use of computer technology. The research findings show that the more clearly nurses understand the positive impact of using technology on the quality of care, the more positive their response to changes in registration and reporting methods. It is not surprising that the research findings found that cognitive instrumental processes and social influence processes have a positive effect on the perceived usefulness of using computer technologies. The unusual finding was the fact that cognitive instrumental processes were the main factor influencing the assimilation of computer technology even though nursing is a social profession.

The role of Hospital-Based Cancer Registries (HBCRs) as information systems in the delivery of evidence-based integrated cancer care: a scoping review

Cancer is a leading cause of mortality, with 10 million deaths in 2020. With the number of people impacted by cancer projected to increase, a better-integrated cancer care is needed. Evidence suggests that Hospital-Based Cancer Registries (HBCRs) that collect administrative and clinical data could improve integrated and equitable evidence-based care. However, the state and HBCR's role in the delivery of integrated cancer care for improved health outcomes, particularly in low- and middle-income countries (LMICs), is poorly understood and is assessed in this scoping review. A systematic search was conducted in April 2020. Thirty articles were included. This review found that while HBCRs have been implemented in several countries, few studies have evaluated the quality and effectiveness of registries, especially in LMICs. HBCRs in LMICs function more as data collection tools than information systems to influence clinical care decisions and monitoring, missing the opportunity to guide cancer care priorities and policies.

Understanding how physician perceptions of job demand and process benefits evolve during CPOE implementation

We examine how physicians' perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians' response to CPOE implementation.

Contradictions and Interventions in Health IS

The study analyzes data collected in two case studies in the healthcare industry, which is characterized by a variety of social and technical elements forming an activity system where all elements interact with each other. The findings indicate that many problems emerging during the implementation of a health information system can be traced back to contradictions between elements of the activity systems that are created or amplified by the new IS. The authors find that some contradictions are latent and become salient when introducing a new IS, while other contradictions are (unintentionally) newly created. Also, the study shows that contradictions are more complex than hitherto assumed and often concern more than two elements of a healthcare activity system. In a similar vein, effective interventions geared toward countering these contradictions are found to account for additional complexity while not always achieving their goal. Drawing on activity theory, the authors develop a framework to coherently synthesize the findings. The study can help increase the understanding of the IS’s role within an activity system and help guide IS implementation projects aimed at avoiding unintended consequences.

Investigation of usability problems of electronic medical record systems in the emergency department

BACKGROUND

Despite the benefits of using electronic medical record (EMR) systems, existing studies show that many healthcare providers are uncertain regarding their usability. The usability issues of these systems decrease their efficiency, discourage clinicians, and cause dissatisfaction among patients, which may result in safety risks and harm.

OBJECTIVE

The aim of this study was to collect and analyze EMR system usability problems from actual users. Practical user interface guidelines were presented based on the medical practices of these users.

METHODS

Employing an online questionnaire with a seven-point Likert scale, usability issues of EMR systems were collected from 200 emergency department healthcare providers (103 physicians (medical doctors) and 97 nurses) from South Korea.

RESULTS

The most common usability problem among the physicians and nurses was generating in-patient selection. This pertained to the difficulty in finding the required information on-screen because of poor visibility and a lack of distinctiveness.

CONCLUSIONS

The major problems of EMR systems and their causes were identified. It is recommended that intensive visual enhancement of EMR system interfaces should be implemented to support user tasks. By providing a better understanding of the current usability problems among medical practitioners, the results of this study can be useful for developing EMR systems with increased effectiveness and efficiency.

Theories Informing eHealth Implementation: Systematic Review and Typology Classification

Background

Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation.

Objective

The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change.

Methods

An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building.

Results

Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6).

Conclusions

Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process.

Can structured EHR data support clinical coding? A data mining approach

Structured data formats are gaining momentum in electronic health records and can be leveraged for decision support and research. Nevertheless, such structured data formats have not been explored for clinical coding, which is an essential process requiring significant manual workload in health organisations. This article explores the extent to which fully structured clinical data can support assignment of clinical codes to inpatient episodes, through a methodology that tackles high dimensionality issues, addresses the multi-label nature of coding and optimises model parameters. The methodology encompasses transformation of raw data to define a feature set, build a data matrix representation, and testing combinations of feature selection methods with machine learning models to predict code assignment. The methodology was tested with a real hospital dataset and showed varying predictive power across codes, while demonstrating the potential of leveraging structuring data to reduce workload and increase efficiency in clinical coding.

Inhibitors of Physicians' Use of Mandatory Hospital Information Systems (HIS)

Physicians' use of information systems continues to be a highly relevant area of information systems research. Although numerous studies have investigated the relationship between hospital physicians and hospital information systems (HIS), a comprehensive framework for assessing the factors which inhibit the use of HIS has yet to be developed. To advance these efforts, this exploratory research takes a qualitative approach to investigate HIS use inhibitors based on interviews with 48 informants and observations from over 40 hours of workplace shadowing in two German hospitals. The findings show that focusing solely on the user does not lead to successful system deployment in hospitals. Rather, the road to success needs to take a combined approach focusing on the user, the process and the system. If these three building blocks are well aligned, correspond with the organizational context and are supported by strong leadership, medical personnel are much more satisfied with the HIS, which results in more effective use.

I want to talk to a real person: theorising avoidance in the acceptance and use of automated technologies

Automated communication systems are increasingly common in mobile and ehealth contexts. Yet, there is reason to believe that some high risk segments of the population might be prone to avoid automated systems even though they are often designed to reach these groups. To facilitate research in this area, avoidance of automated communication (AAC) is theorized - and a measurement instrument validated - across two studies. In study 1, an AAC scale was found to be unidimensional and internally reliable as well as negatively correlated with comfort, perceptions, and intentions to use technology. Moreover, individuals with social phobia had lower AAC scores which was consistent with the idea that they preferred non-human interaction facilitated by automated communication. In study 2, confirmatory factor analysis supported the unidimensional structure of the measure and the instrument once again proved to be reliable. Individuals with lower AAC had greater intentions to utilize automated communication, EHRs, and an automated virtual nurse program. AAC is a disposition that predicts significant variance in intentions and comfort with various automated communication technologies. Avoidance increases with age but may be mitigated by systems that allow participants to opt-out or immediately interact with a live person.

Adequacy of UTAUT in clinician adoption of health information systems in developing countries: The case of Cameroon

PURPOSE

Despite the great potential Health Information Systems (HIS) have in improving the quality of healthcare delivery services, very few studies have been carried out on the adoption of such systems in developing countries. This article is concerned with investigating the adequacy of UTAUT¹ in determining factors that influence the adoption of HIS by clinicians in developing countries, based on the case of Cameroon.

METHODS

A paper-based questionnaire was distributed to clinicians in 4 out of 7 major public hospitals in Cameroon. A modified UTAUT was tested using structural equation modeling (SEM) method to identify the determinants of clinicians' intention to use HIS. Self-efficacy and cost-effectiveness were determinants used to extend the original UTAUT.

RESULTS

228 out of 286 questionnaires were validated for this study. The original UTAUT performed poorly, explaining 12% of the variance in clinicians' intention to use HIS. Age was the only significant moderating factor, improving the model to 46%. Self-efficacy and cost effectiveness has no direct significant effect on HIS adoption in the context of this study.

CONCLUSIONS

The original UTAUT is not adequate in identifying factors that influence the adoption of HIS by clinicians in developing countries. Simplifying the model by using age as the only moderating factor significantly increases the model's ability to predict HIS adoption in this context. Thus, the younger clinicians are more likely and ready to adopt HIS than the older ones. Context-specific should also be used to increase the explanatory power of UTAUT in any given context.