Physicians' adoption of information technology: a consumer behavior approach

Understanding electronic medical record adoption in the United States: communication and sociocultural perspectives

Background

This paper adopts a communication and sociocultural perspective to analyze the factors behind the lag in electronic medical record (EMR) adoption in the United States. Much of the extant research on this topic has emphasized economic factors, particularly, lack of economic incentives, as the primary cause of the delay in EMR adoption. This prompted the Health Information Technology on Economic and Clinical Health Act that allow financial incentives through the Centers of Medicare and Medicaid Services for many health care organizations planning to adopt EMR. However, financial incentives alone have not solved the problem; many new innovations do not diffuse even when offered for free. Thus, this paper underlines the need to consider communication and sociocultural factors to develop a better understanding of the impediments of EMR adoption.

Objective

The objective of this paper was to develop a holistic understanding of EMR adoption by identifying and analyzing the impact of communication and sociocultural factors that operate at 3 levels: macro (environmental), meso (organizational), and micro (individual).

Methods

We use the systems approach to focus on the 3 levels (macro, meso, and micro) and developed propositions at each level drawing on the communication and sociocultural perspectives.

Results

Our analysis resulted in 10 propositions that connect communication and sociocultural aspects with EMR adoption.

Conclusions

This paper brings perspectives from the social sciences that have largely been missing in the extant literature of health information technology (HIT) adoption. In doing so, it implies how communication and sociocultural factors may complement (and in some instances, reinforce) the impact of economic factors on HIT adoption.

A cluster-randomized trial to provide clinicians inhaled corticosteroid adherence information for their patients with asthma

BACKGROUND

Inhaled corticosteroid (ICS) nonadherence is common among patients with asthma; however, interventions to improve adherence have often been complex and not easily applied to large patient populations.

OBJECTIVE

To assess the effect of supplying patient adherence information to primary care providers.

METHODS

Patients and providers were members of a health system serving southeast Michigan. Providers (88 intervention; 105 control) and patients (1335 intervention; 1363 control) were randomized together by practice. Patients were age 5 to 56 years, had a diagnosis of asthma, and had existing prescriptions for ICS medication. Adherence was estimated by using prescription and fill data. Unlike clinicians in the control arm, intervention arm providers could view updated ICS adherence information on their patients via electronic prescription software, and further details on patient ICS use could be viewed by selecting that option. The primary outcome was ICS adherence in last 3 months of the study period.

RESULTS

At the study end for the intention-to-treat analysis, ICS adherence was not different among patients in the intervention arm compared with those in the control arm (21.3% vs 23.3%, respectively; P = .553). However, adherence was significantly higher among patients whose clinician elected to view their detailed adherence information (35.7%) compared with both control arm patients (P = .026) and intervention arm patients whose provider did not view adherence data (P = .002).

CONCLUSIONS

Overall, providing adherence information to clinicians did not improve ICS use among patients with asthma. However, patient use may improve when clinicians are sufficiently interested in adherence to view the details of this medication use.

Trust in online prescription drug information among internet users: the impact on information search behavior after exposure to direct-to-consumer advertising

The proliferation of both manufacturer-controlled and independent medication-related websites has aroused concern among consumers and policy-makers concerning the trustworthiness of Web-based drug information. The authors examine consumers' trust in on-line prescription drug information and its influence on information search behavior. The study design involves a retrospective analysis of data from a 1998 national survey. The findings reveal that trust in drug information from traditional media sources such as television and newspapers transfers to the domain of the Internet. Furthermore, a greater trust in on-line prescription drug information stimulates utilization of the Internet for information search after exposure to prescription drug advertising.