Archer Norm, Cocosila Mihail
DeGroote School of Business, McMaster University, Hamilton, ON, Canada.
J Med Internet Res. 2011 Aug 12;13(3):e57. doi: 10.2196/jmir.1726.
There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations.
We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model.
We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques.
We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers.
Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.
加拿大正在开展一项大规模运动，涉及大量公共资金支出，以提高电子健康记录（EHR）系统的采用率。为了使这项工作成功的机会最大化，必须考虑医生对电子健康记录的看法，因为用户认知是技术创新成功实施的关键。
从医生的角度出发，我们提出一个理论模型，该模型包含有利于或不利于在加拿大医疗实践中采用和使用电子健康记录的行为因素。通过该模型，比较已经使用电子健康记录系统的医生和未使用该系统的医生对电子健康记录的认知。
我们在加拿大各地的执业医生中开展了一项英法双语的在线横断面调查。收集了使用电子健康记录的医生和未使用电子健康记录的医生的数据，并采用结构方程模型（SEM）技术进行分析。
我们从电子健康记录用户中收集到119份回复，从非用户中收集到100份回复，分别得到102名和83名参与者的2个有效样本。该理论采用模型解释了已经使用电子健康记录的医生继续使用电子健康记录的行为意向中55.8%的方差，以及非用户采用此类系统意向中66.8%的方差。发现易用性感知是电子健康记录用户最强烈的动机（总效应为0.525），而有用性感知和易用性感知是促使非用户采用该系统的关键决定因素（总效应分别为0.538和0.519）。用户将与采用电子健康记录相关的总体感知风险视为主要障碍（总效应为-0.371），而非用户仅将风险视为一种微弱的间接阻碍因素。在结构方程模型的13条路径中，有5条在两个样本之间显示出显著差异（在0.05水平）：对使用该系统的普遍疑虑（P = 0.02）、该系统与他们工作相关性的必要性（P < 0.001）以及该系统有用性的必要性（P = 0.049）对电子健康记录非用户比对用户更重要，而采用的总体障碍感知（P = 0.03）和系统易用性感知（P = 0.042）对电子健康记录用户比对非用户更重要。
已经使用此类系统的医生和尚未使用该系统的医生在对电子健康记录系统采用和使用的认知方面差异相对较小。从行为角度来看，为了使新的电子健康记录实施成功的机会最大化，必须通过改进设计、强调电子健康记录与医生工作的相关性以及提供确凿证据证明电子健康记录比非用户预期的更易于使用和更有效，来减轻对此类系统基本原理的普遍疑虑。
