Use and acceptance of an electronic health record: factors affecting physician attitudes

Abstract

The benefits of using electronic health records (EHRs) are well-documented; however, a number of implementation barriers have impeded their widespread use. The literature provides evidence of failed clinical system implementations, due to lack of adoption by users. Health care organizations must be prepared to anticipate and manage changes that will accompany implementation of a new information system. As the key coordinator and provider of patient care, physician acceptance of an EHR application will determine the overall success of a product's implementation. The objective of this study was to determine the individual characteristics and sociotechnical factors that may contribute to physician acceptance of an EHR. A hypothesized causal model grounded in Diffusion of Innovations theory and the Technology Acceptance Model was developed using case study and survey methods, and was tested using structural equation modeling (SEM). An online survey was distributed to 802 faculty, fellow and resident physicians in an acute care teaching institution in the southeastern United States. Overall response rate was 29.8%. The model variables explained over 73% of the variance in EHR attitude and acceptable model fit was achieved. Individual physician characteristics did not correlate with attitudes in this population. Factors contributing to physician acceptance include: management support, physician involvement in selection and implementation, perceptions of the EHR's impact on physician autonomy, doctor-patient relationship, perceived ease of use and perceived usefulness. Study participants also expressed concerns about perceptions of the EHR's potential negative impact on clinical workflow and efficiency. Adequate training was not a significant predictor of attitudes. Significant contributions of this study include development of an EHR Acceptance Model for assessing physician attitudes prior to EHR implementation. Other healthcare institutions may find this framework useful for assessing EHR readiness. The findings may aid software developers in designing products to accommodate multiple clinical specialties and user skill levels. The results provide empirical support for a theory about the impact of sociotechnical factors on physician attitudes about EHR adoption.