Department of Healthcare Professions, University Hospital Campus Bio-Medico, Rome, Italy.
Faculty of Medicine & Surgery, University Campus Bio-Medico, Rome, Italy.
PLoS One. 2020 Jun 4;15(6):e0234108. doi: 10.1371/journal.pone.0234108. eCollection 2020.
The implementation of hospital-wide Electronic Medical Records (EMRs) is still an unsolved quest for many hospital managers. EMRs have long been considered a key factor for improving healthcare quality and safety, reducing adverse events for patients, decreasing costs, optimizing processes, improving clinical research and obtaining best clinical performances. However, hospitals continue to experience resistance from professionals to accepting EMRs. This study combines institutional and individual factors to explain which determinants can trigger or inhibit the EMRs implementation in hospitals, and which variables managers can exploit to guide professionals' behaviours. Data have been collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome. A total of 114 high-quality responses had been received. Results show that both, physicians and nurses, expect many benefits from the use of EMRs. In particular, it is believed that the EMRs will have a positive impact on quality, efficiency and effectiveness of care; handover communication between healthcare workers; teaching, tutoring and research activities; greater control of your own business. Moreover, data show an interplay between individual and institutional determinants: normative factors directly affect perceived usefulness (C = 0.30 **), perceived ease of use (C = 0.26 **) and intention to use EMRs (C = 0.33 **), regulative factors affect the intention to use EMRs (C = -0.21 **), and perceived usefulness directly affect the intention to use EMRs (C = 0.33 **). The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention to use EMRs. Therefore, Management can leverage on power users to motivate, generate and manage change.
医院范围内电子病历 (EMR) 的实施仍然是许多医院管理者尚未解决的难题。长期以来，EMR 一直被认为是提高医疗质量和安全性、减少患者不良事件、降低成本、优化流程、改善临床研究和获得最佳临床效果的关键因素。然而，医院仍然面临着专业人员对接受 EMR 的抵制。本研究结合制度和个人因素，解释了哪些决定因素可以触发或抑制医院 EMR 的实施，以及管理者可以利用哪些变量来引导专业人员的行为。数据是通过对罗马一家意大利大学医院的医生和护士进行调查收集的。共收到 114 份高质量的回复。结果表明，医生和护士都期望从使用 EMR 中获得许多好处。特别是，人们认为 EMR 将对医疗保健的质量、效率和效果产生积极影响；医护人员之间的交接沟通；教学、辅导和研究活动；更好地控制自己的业务。此外，数据显示了个人和制度决定因素之间的相互作用：规范因素直接影响感知有用性 (C = 0.30 **)、感知易用性 (C = 0.26 **) 和使用 EMR 的意图 (C = 0.33 **)；调节因素影响使用 EMR 的意图 (C = -0.21 **)，感知有用性直接影响使用 EMR 的意图 (C = 0.33 **)。分析表明，使用 EMR 的意图的关键决定因素是规范因素（同侪影响）和个人因素（感知有用性），感知有用性也是规范因素和使用 EMR 的意图之间的中介。因此，管理层可以利用权力用户来激励、产生和管理变革。
