Dimitrovski Tomi, Bath Peter A, Ketikidis Panayiotis, Lazuras Lambros
CITY College, University of York Europe Campus, Thessaloniki, Greece.
South-East European Research Centre, Thessaloniki, Greece.
JMIR Med Inform. 2021 Apr 5;9(4):e21109. doi: 10.2196/21109.
Electronic health records (EHRs) represent an important aspect of digital health care, and to promote their use further, we need to better understand the drivers of their acceptance among health care professionals. EHRs are not simple computer applications; they should be considered as a highly integrated set of systems. Technology acceptance theories can be used to better understand users' intentions to use EHRs. It is recommended to assess factors that determine the future acceptance of a system before it is implemented.
This study uses a modified version of the Unified Theory of Acceptance and Use of Technology with the aim of examining the factors associated with intentions to use an EHR application among general practitioners (GPs) in the Republic of North Macedonia, a country that has been underrepresented in extant literature. More specifically, this study aims to assess the role of technology acceptance predictors such as performance expectancy, effort expectancy, social influence, facilitating conditions, job relevance, descriptive norms, and satisfaction with existing eHealth systems already implemented in the country.
A web-based invitation was sent to 1174 GPs, of whom 458 completed the questionnaire (response rate=40.2%). The research instrument assessed performance expectancy, effort expectancy, facilitating conditions, and social influence in relation to the GPs' intentions to use future EHR systems. Job relevance, descriptive norms, satisfaction with currently used eHealth systems in the country, and computer/internet use were also measured.
Hierarchical linear regression analysis showed that effort expectancy, descriptive norms, social influence, facilitating conditions, and job relevance were significantly associated with intentions to use the future EHR system, but performance expectance was not. Multiple mediation modeling analyses further showed that social influence (z=2.64; P<.001), facilitating conditions (z=4.54; P<.001), descriptive norms (z=4.91; P<.001), and effort expectancy (z=5.81; P=.008) mediated the association between job relevance and intentions. Finally, moderated regression analysis showed that the association between social influence and usage intention was significantly moderated (P=.02) by experience (B=.005; 95% CI 0.001 to 0.010; β=.080). In addition, the association between social influence and intentions was significantly moderated (P=.02) by age (B=.005; 95% CI 0.001 to 0.010; β=.077).
Expectations of less effort in using EHRs and perceptions on supportive infrastructures for enabling EHR use were significantly associated with the greater acceptance of EHRs among GPs. Social norms were also associated with intentions, even more so among older GPs and those with less work experience. The theoretical and practical implications of these findings are also discussed.
电子健康记录（EHRs）是数字医疗保健的一个重要方面，为了进一步推广其使用，我们需要更好地了解医疗保健专业人员接受它们的驱动因素。电子健康记录不是简单的计算机应用程序；它们应被视为一套高度集成的系统。技术接受理论可用于更好地理解用户使用电子健康记录的意图。建议在系统实施之前评估决定其未来接受度的因素。
本研究使用技术接受与使用统一理论的修改版本，旨在研究北马其顿共和国全科医生（GPs）中与使用电子健康记录应用程序意图相关的因素，该国在现有文献中的代表性不足。更具体地说，本研究旨在评估技术接受预测因素的作用，如绩效期望、努力期望、社会影响、便利条件、工作相关性、描述性规范以及对该国已实施的现有电子健康系统的满意度。
向1174名全科医生发送了基于网络的邀请，其中458人完成了问卷（回复率 = 40.2%）。该研究工具评估了与全科医生使用未来电子健康记录系统意图相关的绩效期望、努力期望、便利条件和社会影响。还测量了工作相关性、描述性规范、对该国目前使用的电子健康系统的满意度以及计算机/互联网使用情况。
分层线性回归分析表明，努力期望、描述性规范、社会影响、便利条件和工作相关性与使用未来电子健康记录系统的意图显著相关，但绩效期望并非如此。多重中介模型分析进一步表明，社会影响（z = 2.64；P <.001）、便利条件（z = 4.54；P <.001）、描述性规范（z = 4.91；P <.001）和努力期望（z = 5.81；P =.008）介导了工作相关性与意图之间的关联。最后，调节回归分析表明，社会影响与使用意图之间的关联受到经验的显著调节（P =.02）（B =.005；95%置信区间0.001至0.010；β =.080）。此外，社会影响与意图之间的关联受到年龄的显著调节（P =.02）（B =.005；95%置信区间0.001至0.010；β =.077）。
对使用电子健康记录时付出更少努力的期望以及对支持电子健康记录使用的基础设施的看法与全科医生对电子健康记录的更高接受度显著相关。社会规范也与意图相关，在年长的全科医生和工作经验较少的医生中更是如此。还讨论了这些发现的理论和实际意义。
