Maillet Éric, Mathieu Luc, Sicotte Claude
University of Montreal Hospital Center, Quebec, Canada.
Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.
Int J Med Inform. 2015 Jan;84(1):36-47. doi: 10.1016/j.ijmedinf.2014.09.004. Epub 2014 Oct 3.
End-user acceptance and satisfaction are considered critical factors for successful implementation of an Electronic Patient Record (EPR). The aim of this study was to explain the acceptance and actual use of an EPR and nurses' satisfaction by testing a theoretical model adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT).
A multicenter cross-sectional study was conducted in the medical-surgical wards of four hospitals ranked at different EPR adoption stages. A randomized stratified sampling approach was used to recruit 616 nurses. Structural equation modeling techniques were applied.
Support was found for 13 of the model's 20 research hypotheses. The strongest effects are those between performance expectancy and actual use of the EPR (r=0.55, p=0.006), facilitating conditions and effort expectancy (r=0.45, p=0.009), compatibility and performance expectancy (r=0.39, p=0.002). The variables explained 33.6% of the variance of actual use, 54.9% of nurses' satisfaction, 50.2% of performance expectancy and 52.9% of effort expectancy.
Many results of this study support the conclusions of prior research, but some take exception, such as the non-significant relationship between the effort expectancy construct and actual use of the EPR. The results highlight the importance of the mediating effects of the effort expectancy and performance expectancy constructs. Compatibility of the EPR with preferred work style, existing work practices and the values of nurses were the most important factors explaining nurses' satisfaction. The results reveal the complexity of this change and suggest several avenues for future research and for the implementation of IT in healthcare.
终端用户的接受度和满意度被视为成功实施电子病历（EPR）的关键因素。本研究旨在通过测试一个改编自技术接受与使用统一理论（UTAUT）的理论模型，来解释电子病历的接受度、实际使用情况以及护士的满意度。
在处于不同电子病历采用阶段的四家医院的内科-外科病房开展了一项多中心横断面研究。采用随机分层抽样方法招募了616名护士。应用了结构方程建模技术。
该模型的20个研究假设中有13个得到了支持。最强的影响存在于绩效期望与电子病历的实际使用之间（r = 0.55，p = 0.006）、促进条件与努力期望之间（r = 0.45，p = 0.009）、兼容性与绩效期望之间（r = 0.39，p = 0.002）。这些变量解释了实际使用方差的33.6%、护士满意度方差的54.9%、绩效期望方差的50.2%以及努力期望方差的52.9%。
本研究的许多结果支持了先前研究的结论，但也有一些例外，比如努力期望构念与电子病历实际使用之间的关系不显著。结果凸显了努力期望和绩效期望构念的中介作用的重要性。电子病历与偏好的工作方式、现有工作实践以及护士价值观的兼容性是解释护士满意度的最重要因素。结果揭示了这一变革的复杂性，并为未来研究以及医疗保健领域信息技术的实施提出了几条途径。
