Acceptance and use of electronic medical records: An exploratory study of hospital physicians’ salient beliefs about HIT systems

Abstract

If a hospital keeps electronic medical records (EMRs), the underlying health information system is the primary repository and source of patient-related data for hospital physicians. Even though the benefits and improvements attained through health information technology (HIT) are widely acknowledged, EMR adoption rates are surprisingly low in German hospitals. Since there is no ‘pull’ to use EMR systems, we theorize that low penetration of EMR systems could be in part explained by physicians’ antipathy towards computerized medical records. In order to examine physicians’ salient beliefs about EMRs and EMR usage and to identify the processes that form them, we conducted a multi-case study in German hospitals, drawing on concepts from Social Cognitive Theory and the Unified Theory of Acceptance and Use of Technology (UTAUT) to elicit beliefs and structure our analysis. This study sheds light on different types of beliefs and the belief-forming process and their impact on HIT acceptance and use. Our findings indicate that HIT acceptance and use is not solely impacted by cognitive behavioural and environmental factors, as proposed by UTAUT, but also by personal factors such as self-efficacy and emotions. Furthermore, our study provides evidence of continuous reciprocal causation across behavioural, personal and environmental beliefs. The findings indicate that existing technology acceptance models need to be modified for the specific health-care context by adapting the range, meaning and scope of constructs.