Factors determining nurse acceptance of hospital information systems

Health professionals' technology readiness on the acceptance of teleradiology in the Amhara regional state public hospitals, northwest Ethiopia: Using technology readiness acceptance model (TRAM)

BACKGROUND

Considering individual differences caused by personality differences is crucial for end users' technology acceptance. However, previous studies overlooked the influence of users' technology readiness on technology acceptance. This study, therefore, aimed to evaluate the influence of technology readiness on teleradiology acceptance in the Amhara Regional State Public Hospitals using a technology readiness acceptance model.

METHODS

An institutional-based cross-sectional mixed study design was conducted in September 2021 among 547 health professionals working at sixteen public hospitals in the Amhara region of northwest Ethiopia. Eight key informants were interviewed to explore organizational-related factors. Face-to-face and Google Meet approaches were used to collect the data. We applied structural equation modeling to investigate the influence of technology readiness on health professionals' teleradiology acceptance using Analysis of Moment Structures Version 23 software.

RESULTS

Of the total participants, 70.2% and 85.7% were ready and intended to use teleradiology, respectively. According to technology readiness measuring constructs, optimism and innovativeness positively influenced health professionals' technology acceptance. Perceived ease of use and perceived usefulness showed a statistically positive significant effect on health professionals' intention to use teleradiology. In addition, a statistically significant mediation effect was observed between technology readiness measuring constructs and behavioral intention to use. Furthermore, a shortage of budget, inadequate infrastructure, and users' lack of adequate skills were reported as critical organizational challenges.

CONCLUSIONS

We found a higher proportion of readiness and intention to use teleradiology among health professionals. Personality difference measuring constructs and organizational factors played considerable influence on teleradiology acceptance. Therefore, before the actual implementation of teleradiology, ensuring the system's user-friendliness, improving infrastructure, allocating an adequate budget, and availing of capacity-building opportunities are recommended.

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.

Development an extended-information success system model (ISSM) based on nurses' point of view for hospital EHRs: a combined framework and questionnaire

Background

Understanding the hospital EHR success rate has great benefits for hospitals. The present study aimed to 1-Propose an extended-ISSM framework and a questionnaire in a systematic manner for EHR evaluation based on nurses’ perspectives, 2-Determine the EHR success rate, and 3-Explore the effective factors contributing to EHR success.

Methods

The proposed framework was developed using ISSM, TAM3, TTF, HOT-FIT, and literature review in seven steps. A self-administrated structured 65-items questionnaire was developed with CVI: 90.27% and CVR: 94.34%. Construct validity was conducted using EFA and CFA. Eleven factors were identified, collectively accounting for 71.4% of the total variance. In the EFA step, 15 questions and two questions in EFA were excluded. Finally, 48 items remained in the framework including dimensions of technology, human, organization, ease of use, usefulness, and net benefits. The overall Cronbach’s alpha value was 93.4%. In addition, the hospital EHR success rate was determined and categorized. In addition, effective factors on EHR success were explored.

Results

In total, 86 nurses participated in the study. On average, the “total hospital EHR success rate” was moderate. The total EHR success rates was ranging from 47.09 to 74.96%. The results of the Kruskal–Wallis test showed that there was a significant relationship between “gender” and “self-efficacy” (p-value: 0.042). A reverse relation between “years of experience using computers” and “training” (p-value: 0.012) was observed. “Years of experience using EHR” as well as “education level” (p-value: 0.001) and “ease of use” had a reverse relationship (p-value: 0.034).

Conclusions

Our findings underscore the EHR success based on nurses’ viewpoint in a developing country. Our results provide an instrument for comparison of EHR success rates in various hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01800-1.

Explaing users' technology acceptance through national cultural values in the hospital context

Background

Current research demonstrates that health information technology can improve the efficiency and quality of health services. However, many implementation projects have failed due to behavioural problems associated with technology usages, such as underuse, resistance, sabotage, and even rejection by potential users. Therefore, user acceptance was one of the main factors contributing to the success of health information technology implementation. However, research suggests that behavioural models do not universally hold across cultures.

The present article considers national cultural values (power distance, uncertainty avoidance, individualism/collectivism, masculinity/femininity, and time orientation) as individual difference variables that affect user behaviour and incorporates them into the Technology Acceptance Model (TAM) as moderators of technology acceptance relationships. Therefore, this research analyses which national cultural values affect technology acceptance behaviour in hospitals.

Methods

The authors develop and test seven hypotheses regarding this relationship using the partial least squares (PLS) technique, a structural equation modelling method. The authors collected data from 160 questionnaires completed by clinicians and non-clinicians working in one hospital.

Results

The findings show that uncertainty avoidance, masculinity/femininity, and time orientation are the national cultural values that affect technology acceptance in hospitals. In particular, individuals with masculine cultural values, higher uncertainty avoidance, and a long-term orientation influence behavioural intention to use technology.

Conclusion

The bureaucratic model still decisively characterises the Italian health sector and consequently affects the choices of firms and workers, including the choice of technology adoption. Cultural values of masculinity, risk aversion, and long-term orientation affect intention to use through social norms rather than through perceived utility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07488-3.

The Use of Digital Healthcare Platforms During the COVID-19 Pandemic: the Consumer Perspective

BACKGROUND

The spending on digital healthcare solutions is estimated to reach EUR 232 billion by 2025. Digital healthcare platforms are making transformative changes to conventional healthcare processes which can provide many beneficial improvements for both citizen and government provision to society. These benefits are obvious during pandemics such as Covid-19, when most healthcare services are offered through digital means.

OBJECTIVE

The objective of this study is to measure the role of trust and information quality when using digital healthcare platforms. These constructs are integrated with the Unified Theory of Acceptance and Use of Technology (UTAUT) to provide a better understanding of the consumer perspective regarding the use of digital healthcare platforms.

METHODS

Online structured self-administered questionnaire was utilized to collect the data. A sample consisting of 249 respondents participated in the questionnaire. Descriptive analysis was used to characterize the attributes of participants, and other statistical tests were conducted to ensure the reliability and validity of the survey. The model of the study was evaluated using Structural Equation Modelling (SEM) to explain the extent of the relationship among latent variables.

RESULTS

The study determined that facilitating conditions (t=0.233, p=0.023) and trust (t=0.324, p=0.005) had a significant impact on consumers' behavioral intention of using such platforms during Covid-19 pandemic.

CONCLUSION

This study highlighted the importance of facilitating conditions and trust factors for healthcare consumers of digital healthcare platforms especially during the pandemic time.

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.

Determining Factors Affecting Nurses' Acceptance of a Care Plan System Using a Modified Technology Acceptance Model 3: Structural Equation Model With Cross-Sectional Data

Background

Health information technology is used in nursing practice worldwide, and holistic patient care planning can serve as a guide for nursing practice to ensure quality in patient-centered care. However, few studies have thoroughly analyzed users’ acceptance of care plan systems to establish individual plans.

Objective

Based on the technology acceptance model 3 (TAM3), a user technology acceptance model was established to explore what determines the acceptance of care plan systems by users in clinical settings.

Methods

Cross-sectional quantitative data were obtained from 222 nurses at eight hospitals affiliated with public organizations in Taiwan. Using the modified TAM3, the collected data were employed to analyze the determinants of user acceptance of a care plan system through structural equation modeling (SEM). We also employed moderated multiple regression analysis and partial least squares–SEM to test the moderating effects.

Results

We verified all significant effects from the use of a care plan system among bivariate patterns in the modified TAM3, except for moderating effects. Our results revealed that the determinants of perceived usefulness and perceived ease of use significantly influenced perceived usefulness and perceived ease of use, respectively. The results also indicated that nurses’ perceptions of subjective norm (path coefficient=.25, P<.001), perceived ease of use (path coefficient=.32, P<.001), and perceived usefulness (path coefficient=.31, P<.001) had significantly positive effects on their behavioral intention to use the care plan system, accounting for 69% of the total explained variance.

Conclusions

By exploring nurses’ acceptance of a care plan system, this study revealed relationships among the variables in TAM3. Our results confirm that the modified TAM3 is an innovative assessment instrument that can help managers understand nurses’ acceptance of health information technology in nursing practice to enhance the adoption of health information technology.

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.

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.’

Acute care nurses' perceptions of electronic health record use: A mixed method study

AIM

The overall aim of this study is to examine nurses' perceptions of electronic health record use in an acute care hospital setting.

DESIGN

This study uses a sequential mixed methods design in two phases.

METHODS

Phase one consists of a survey of Registered Nurses to understand nurses' perceptions of electronic health record use. Phase two is comprised of focus groups of a subsample from phase one. Data collection occurred from November 2015 - August 2016 and was done in Toronto, Canada.

RESULTS

In phase one, navigation was found to be a predictor of nurses' perceptions of electronic health record use. In phase two, participants discussed the following five topics: (1) navigation; (2) functionality; (3) organizational standards; (4) documentation workload and (5) issues of system performance and response time. This study has implications for organizations implementing electronic health records, nursing leaders and electronic health record vendors.

A Systematic Review of the Technology Acceptance Model in Health Informatics

BACKGROUND

One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM).

OBJECTIVE

This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction.

METHOD

An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM.

RESULTS

The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered.

CONCLUSION

Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Exploring the role of the nurse manager in supporting point-of-care nurses' adoption of electronic health records: protocol for a qualitative research study

INTRODUCTION

An increasing number of electronic health record (EHR) systems have been implemented in clinical practice environments where nurses work. Findings from previous studies have found that a number of intended benefits of the technology have not yet been realised to date, partially due to poor system adoption among health professionals such as nurses. Previous studies have suggested that nurse managers can support the effective adoption and use of the technology by nurses. However, no known studies have identified what role nurse managers have in supporting technology adoption, nor the specific strategies that managers can employ to support their staff. Therefore, the purpose of this research is to better understand the role of the nurse manager in point-of-care nurses' use of EHRs, and to identify strategies that may be effective in supporting clinical adoption.

METHODS AND ANALYSIS

This study will use a qualitative descriptive design. Interviews with both nurse managers and point-of-care nursing staff will be conducted in a Canadian mental health and addiction healthcare organisation where an EHR has been implemented. A semistructured interview guide will be used, and interviews will be audio recorded. Transcripts will be analysed using a directed content analysis technique. Strategies to ensure the trustworthiness of the data analysis procedure and findings will be employed.

ETHICS AND DISSEMINATION

Ethical approval for this study has been obtained. Dissemination strategies may include a paper submission to a peer-reviewed journal, a conference submission and meetings to share findings with the study site leadership team. Findings from this research will be used to inform a future study which aims to assess levels of competencies and perform a psychometric analysis of the Nursing Informatics Competency Assessment for the Nurse Leader instrument in a Canadian context.

Perceived usefulness and perceived ease of use of electronic health records among nurses: Application of Technology Acceptance Model

BACKGROUND

Electronic health records (EHRs) are increasingly being implemented in healthcare organizations but little attention has been paid to the degree to which nurses as end-users will accept these systems and subsequently use them.

OBJECTIVES

To explore nurses' perceptions of usefulness and ease-of-use of EHRs. The relationship between these constructs was examined, and its predictors were studied.

METHOD

A national exploratory study was conducted with 1539 nurses from 15 randomly selected hospitals, representative of different regions and healthcare sectors in Jordan. Data were collected using a self-administered questionnaire, which was based on the Technology Acceptance Model. Correlations and linear multiple regression were utilized to analyze the data.

RESULTS

Jordanian nurses demonstrated a positive perception of the usefulness and ease-of-use of EHRs, and subsequently accepted the technology. Significant positive correlations were found between these two constructs. The variables that predict usefulness were the gender, professional rank, EHR experience, and computer skills of the nurses. The perceived ease-of-use was affected by nursing and EHR experience, and computers skills.

CONCLUSION

This study adds to the growing body of knowledge on issues related to the acceptance of technology in the health informatics field, focusing on nurses' acceptance of EHRs.

Information Processing in Nursing Information Systems: An Evaluation Study from a Developing Country

BACKGROUND

In recent years, information technology has been introduced in the nursing departments of many hospitals to support their daily tasks. Nurses are the largest end user group in Hospital Information Systems (HISs). This study was designed to evaluate data processing in the Nursing Information Systems (NISs) utilized in many university hospitals in Iran.

METHODS AND MATERIALS

This was a cross-sectional study. The population comprised all nurse managers and NIS users of the five training hospitals in Khorramabad city (N = 71). The nursing subset of HIS-Monitor questionnaire was used to collect the data. Data were analyzed by the descriptive-analytical method and the inductive content analysis.

RESULTS

The results indicated that the nurses participating in the study did not take a desirable advantage of paper (2.02) and computerized (2.34) information processing tools to perform nursing tasks. Moreover, the less work experience nurses have, the further they utilize computer tools for processing patient discharge information. The "readability of patient information" and "repetitive and time-consuming documentation" were stated as the most important expectations and problems regarding the HIS by the participating nurses, respectively.

CONCLUSIONS

The nurses participating in the present study used to utilize paper and computerized information processing tools together to perform nursing practices. Therefore, it is recommended that the nursing process redesign coincides with NIS implementation in the health care centers.

Nurses' Satisfaction With Using Nursing Information Systems From Technology Acceptance Model and Information Systems Success Model Perspectives: A Reductionist Approach

Nursing information systems can enhance nursing practice and the efficiency and quality of administrative affairs within the nursing department and thus have been widely considered for implementation. Close alignment of human-computer interaction can advance optimal clinical performance with the use of information systems. However, a lack of introduction of the concept of alignment between users' perceptions and technological functionality has caused dissatisfaction, as shown in the existing literature. This study provides insight into the alignment between nurses' perceptions and how technological functionality affects their satisfaction with Nursing Information System use through a reductionist perspective of alignment. This cross-sectional study collected data from 531 registered nurses in Taiwan. The results indicated that "perceived usefulness in system quality alignment," "perceived usefulness in information quality alignment," "perceived ease of use in system quality alignment," "perceived ease of use in information quality alignment," and "perceived ease of use in service quality alignment" have significantly affected nurses' satisfaction with Nursing Information System use. However, "perceived usefulness in service quality alignment" had no significant effect on nurses' satisfaction. This study also provides some meaningful implications for theoretical and practical aspects of design.

A meta-analysis of e-health applications acceptance

Purpose

The increasing importance of electronic health (e-health) has raised the significance of exploring the factors influencing the users’ acceptance of e-health applications. There has been an extensive usage of the technology acceptance model (TAM) in e-health applications acceptance research. However, not all TAM relationships are borne out in all the studies. There is a variation in predicted effects in several studies with different user type and application type. The purpose of this paper is to bridge a research gap by providing a holistic view of the e-health applications acceptance research by integrating the findings of existing relevant literature.

Design/methodology/approach

A statistical meta-analysis of the effect size of causal relationships between common TAM constructs was conducted on 111 peer-reviewed academic studies published in various journals.

Findings

The results confirm the validity and robustness of the TAM in e-health applications acceptance research. Further, a moderator analysis based on user type and e-health application type demonstrated that the effect size of causal relationships between TAM constructs majorly depends on the user type, but not on e-health application type.

Research limitations/implications

This research provides a ready reference of the existing studies on e-health applications acceptance to the researchers. Further, if researchers or practitioners want to learn more about the particular user or application type, they may find the results valuable.

Practical implications

This research suggests that the general public can be used as the surrogates for patients in e-health applications acceptance research. The implementation strategy found successful for medical staff may not work for general public and patients. This research also suggests ways to enhance acceptance of e-health applications among different user groups.

Originality/value

The research is original and is based on the existing literature and its interpretation.

Confirmation of Expectations and Satisfaction with Hospital Information Systems: A Nursing Perspective

OBJECTIVES

This study aimed to compare nurses' satisfaction with, and expectations of, hospital information systems in two teaching hospitals.

METHODS

This was a survey study, which was completed in 2014. The potential participants were 267 nurses who worked in two teaching hospitals and used the same hospital information system. Data were collected using two questionnaires. Both questionnaires were examined in terms of content validity and reliability.

RESULTS

The results showed that, for a majority of nurses, their expectations of the system were not met in either hospital. Moreover, there was a significant association between the nurses' expectations and the perceived usefulness of the systems (p < 0.001), between the nurses' expectations and their satisfaction with the systems (p < 0.001), and between the perceived usefulness and nurses' satisfaction with the systems (p < 0.001).

CONCLUSIONS

The results suggested that, apart from the technical issues of implementing clinical information systems, non-technical factors should be taken into account. Among them, the nature of clinical tasks and the organizational culture require more attention to allow a successful system to be designed and implemented.

Nurse acceptance of electronic health record technology: a literature review

Electronic health records are now being installed globally in healthcare organisations in an effort to provide a more efficient and safer healthcare environment. Regardless of the tremendous amount of attention paid to this area now, the benefits of the technology are often not fully realised. This may be the result of healthcare administrators not being able to implement electronic health records effectively due to inadequate user acceptance of the technology by the largest group of healthcare professionals – nurses. Using the technology acceptance model and the DeLone and McLean model for information system success, the authors have reviewed the published studies that have applied these models to both nurses and electronic health records. Results of the literature review suggest that a modification of the models may provide a better explanation of nurses’ acceptance of electronic health records.

An importance-performance analysis of hospital information system attributes: A nurses' perspective

PURPOSE

Health workers have numerous concerns about hospital IS (HIS) usage. Addressing these concerns requires understanding the system attributes most important to their satisfaction and productivity. Following a recent HIS implementation, our objective was to identify priorities for managerial intervention based on user evaluations of the performance of the HIS attributes as well as the relative importance of these attributes to user satisfaction and productivity outcomes.

PROCEDURES

We collected data along a set of attributes representing system quality, data quality, information quality, and service quality from 154 nurse users. Their quantitative responses were analysed using the partial least squares approach followed by an importance-performance analysis. Qualitative responses were analysed using thematic analysis to triangulate and supplement the quantitative findings.

MAIN FINDINGS

Two system quality attributes (responsiveness and ease of learning), one information quality attribute (detail), one service quality attribute (sufficient support), and three data quality attributes (records complete, accurate and never missing) were identified as high priorities for intervention.

CONCLUSIONS

Our application of importance-performance analysis is unique in HIS evaluation and we have illustrated its utility for identifying those system attributes for which underperformance is not acceptable to users and therefore should be high priorities for intervention.

The Relationship between User Satisfaction, System Attributes and the Motivating Potential of System Use

User satisfaction (US) is an important information systems success measure. This paper contributes to our understanding of US in workplace settings by conceptualizing US as resulting from user evaluations of both the attribute level performance of the system and its impacts on the motivating potential of their work. Data was collected from a sample of 154 nurses in a regional public hospital in South Africa who are users of an integrated hospital information system. The authors considered that use of the system has implications for the motivating potential of work through its impacts on skill variety, task identity, significance, autonomy, and work performance. Their results show that a system's impact on motivating potential is significant for US. Moreover, system quality, information quality, and user support attributes of the IS have significant direct effects on US as well as indirect effects through motivating potential. A high performing system is thus important for US as it provides a platform to increase the motivating potential of work.

Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health: A Cross-sectional Survey

BACKGROUND

To our knowledge, no evidence is available on health care professionals' use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses' personal use of ePHRs using a modified technology acceptance model.

OBJECTIVES

To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses' own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers' use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use.

METHODS

A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect.

RESULTS

Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses' own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses.

CONCLUSIONS

Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their individual patients.

Task-technology fit of video telehealth for nurses in an outpatient clinic setting

BACKGROUND

Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task-technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task-technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes.

MATERIALS AND METHODS

The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time-motion study. Qualitative and quantitative results were merged and analyzed within the task-technology fit framework to determine the workflow fit of video telehealth for APRN care coordination.

RESULTS

Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task-technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN.

CONCLUSIONS

Telehealth must provide the right information to the right clinician at the right time. Evaluating task-technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology.

Evaluation of an online orientation program for new healthcare employees

Online learning is one of the newest efforts of mainstream healthcare education. It has been cited as providing both an efficient and effective alternative learning medium. This study explored the acceptance of an online orientation program by new healthcare employees and identified several critical factors affecting online learning outcomes. The study applied triangulation methods including surveys, interviews, and test scores. Data were captured from 154 questionnaires (with a response rate of 78.2%) with related test scores and 13 participant interviews. The results showed that new healthcare employees were positive toward the computer-based learning program. "Perceived ease of use" and "perceived usefulness" were the major variables predicting technology acceptance, whereas "learner satisfaction" and "continued intention to use" were the major indices for the learning outcomes. Test scores, however, did not reveal any statistical impact. Additionally, human-computer interaction, instant feedback, and program content were commented on as factors affecting learning outcomes. Therefore, online learning is suitable for new healthcare employees, both in the orientation stage and as a follow-up learning method. The results of this study can help support the development of educational technology online programs.

The USE IT-adoption-model to predict and evaluate adoption of information and communication technology in healthcare

BACKGROUND AND OBJECTIVE

The USE IT-model integrates theories about adoption and diffusion of innovations and is suitable to predict and evaluate the success of an information system from a user's perspective. The USE IT-model consists of four determinants: relevance, requirements, resources and resistance, which are measured at the macro-level (organizational), and at the micro-level (individual). After applying the USE IT approach in several researches we evaluated and updated the USE IT-model.

METHODS

We used the USE IT-model in ten case studies in healthcare and compared the results of the studies with the determinants and dimensions of the USE IT-model.

RESULTS

The quality of the implementation process is part of the innovation process-dimension and therefore relocated as a dimension of macro-resistance. The improvements and value in the relevance determinant are made more concrete by quality, efficiency, effectiveness, and task support. The dimensions of micro-resistance are reduced, and the dimension negative consequences is added. Also the dimensions of macro- and micro-requirements are made more specific to express the importance of information quality, availability and accessibility.

DISCUSSION AND CONCLUSION

The research resulted in the updated USE IT-adoption-model to predict and evaluate the adoption of information systems in healthcare. The structure and determinants of the original USE IT-model with a distinction between the macro- and micro-level remained unchanged.

Factors of accepting pain management decision support systems by nurse anesthetists

BACKGROUND

Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective.

METHODS

A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool.

RESULTS

The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists' perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists' perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R(2)=.487) and perceived usefulness (β=.443, p<.001, R(2)=.646) significantly affected nurse anesthetists' PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated.

CONCLUSIONS

The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development.