Electronic Health Record Acceptance Research Articles

Assessment of Factors Influencing Healthcare Provider’s Acceptance of Electronic Health Record in Jordanian Hospitals

Acceptance of electronic health record systems is considered an essential factor for effective implementation among healthcare providers. In an attempt to understand healthcare providers’ perceptions of electronic health record systems implementation and evaluate the factors influencing healthcare providers’ acceptance of electronic health record systems, the current research examines the effects of individual (user) context factors and organisational context factors using the technology acceptance model. A quantitative cross-sectional survey design was used, in which 319 healthcare providers from five public hospitals participated in the present study. Data were collected using a self-administered questionnaire, which was based on the technology acceptance model. Jordanian healthcare providers demonstrated positive perceptions of the usefulness and ease of use of the electronic health record systems and subsequently accepted the technology. The results indicated that they had a significant effect on the perceived usefulness and perceived ease of use of the electronic health record, which in turn was related to positive attitudes towards the electronic health record systems as well as the intention to use them. User attributes, organisational competency, management support and training and education are essential variables in predicting healthcare providers’ acceptance towards electronic health records. These findings should be considered by healthcare organisations’ administration to introduce an effective system to other healthcare organisations.

Impact of EHRs on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study.

This study explores the association between nursing burnout and Electronic Health Record (EHR) use in a Saudi Arabian hospital adopting an advanced EHR system. Utilising a mixed-methods approach, the research combines quantitative analysis of 282 survey responses and qualitative interviews from 21 registered nurses. Despite high EHR acceptance, negative perceptions and stress related to EHR use were identified. Findings indicate a weak link between EHR use and burnout, with resilience acting as a mitigating factor. Specific stressors, including documentation workload and usability issues, were countered by individual and organisational resilience. The study introduces a novel conceptual model emphasising the pivotal role of resilience at both levels in mitigating EHR-related burnout. Recommendations include fostering resilience-building strategies in EHR implementation processes and usability to prevent burnout, emphasising self-care practices, promoting work-life balance, and improving health information infrastructure.

Lessons Learned About System-Level Improvement in Serious Illness Communication: A Qualitative Study of Serious Illness Care Program Implementation in Five Health Systems.

Serious illness communication is a key element of high-quality care, but it is difficult to implement in practice. The Serious Illness Care Program (SICP) is a multifaceted intervention that contributes to more, earlier, and better serious illness conversations and improved patient outcomes. This qualitative study examined the organizational and implementation factors that influenced improvement in real-world contexts. The authors performed semistructured interviews of 30 health professionals at five health systems that adopted SICP as quality improvement initiatives to investigate the organizational and implementation factors that appeared to influence improvement. After SICP implementation across the organizations studied, approximately 4,661 clinicians have been trained in serious illness communication and 56,712 patients had had an electronic health record (EHR)-documented serious illness conversation. Facilitators included (1) visible support from leaders, who financially invested in an implementation team and champions, expressed the importance of serious illness communication as an institutional priority, and created incentives for training and documenting serious illness conversations; (2) EHR and data infrastructure to foster performance improvement and accountability, including an accessible documentation template, a reporting system, and customized data feedback for clinicians; and (3) communication skills training and sustained support for clinicians to problem-solve communication challenges, reflect on communication experiences, and adapt the intervention. Inhibitors included leadership inaction, competing priorities and incentives, variable clinician acceptance of EHR and data tools, and inadequate support for clinicians after training. Successful implementation appeared to rely on multilevel organizational strategies to prioritize, reward, and reinforce serious illness communication. The insights derived from this research may function as an organizational road map to guide implementation of SICP or related quality initiatives.

Complexities of health and acceptance of electronic health records for the Austrian elderly population

We examine the personal health situation and how the complexities thereof affect the elderly Austrians’ willingness to accept electronic health records (EHR). Using data from the sixth wave of the SHARE survey in Austria, we find the complexity of individual health problems and the social integration of individuals influencing the acceptance of EHR. The higher the degree of multimorbidity, the more medication is prescribed, and the higher the number of hospital admissions, the higher is the acceptance of EHR. Having a chronical illness has a positive effect on EHR acceptance, whereas a pessimistic attitude and lack of joy in life, as indicators of depressive mood, have a negative impact. The results are mainly driven by women and younger patients aged between 50 and 70. People with poor social connection express lower acceptance of EHR.

Acceptance of Electronic Health Records in Traditional Malay Medicine: An Exploratory Prototyping Approach

The usage of electronic health records is widely used today in the modern medicine field due to its immense benefits. These benefits include and are not limited to allowing physician to access a patient’s chart remotely, provide alerts to a potential medication error and critical lab values. However, the usage of this technology in Traditional Malay Medicine is limited. This paper explores the acceptance usage of electronic health records in Traditional Malay Medicine in five healthcare organisations including private Traditional Malay Medicine practitioners in Malaysia. This research utilizes the exploratory prototyping approach where a prototype, MyPostnatalSys is developed and used to gain constructive feedback of the acceptance of electronic health records. MyPostnatalSys, an electronic health record prototype, was developed for integrating Traditional Malay Medicine and Modern Medicine services using an interoperability standard, HL7. The purpose of interoperability standards is to ensure patient data can be transmitted across multi-platform systems seamlessly. The results show that more than 90% respondents have shown a positive acceptance on the usage of electronic health records in Traditional Malay Medicine. However, there may exist some resistance in accepting electronic health records technology in private Traditional Malay Medicine practitioners. However Traditional Malay practitioners trained by a government led initiative for women’s health, Mamacare programme, are more open to accept the implementation. This shows that upskilling programmes such as Mamacare can reduce the barriers of acceptance in electronic health records in Traditional Malay practitioners.

Electronic Health Record Acceptance by Physicians: A Single Hospital Experience in Daily Practice

Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.

Using HL7 FHIR to achieve interoperability in patient health record.

The rapid growth and acceptance of Electronic Health Records (EHRs) and standards to exchange EHRs have improved various aspects of health practices and patient care. However, the data captured in an EHR is only accessible to the providers and specialists within an organization, but not the patient. The concept of a Personal Health Record (PHR) is to allow the patients to record and manage their health data beyond EHR and if possible, see the EHR data in the PHR. Experts agree that bi-directional communication between the PHR and EHR allows the PHR to be more effective and a valuable tool for both the providers and patients. Communicating near real-time patient recorded data in PHR with an EHR will allow the provider(s) to make appropriate clinical decisions and patients can see any changes to his/her diagnostics or treatment plans. This research explores and critically analyzes HL7 FHIR to design and prototype an interoperable mobile PHR that conforms to the HL7 PHR Functional Model and allows bi-directional communication with OpenEMR.

Perceived usefulness and perceived ease of use of electronic health records among nurses: Application of Technology Acceptance Model

ABSTRACTBackground: Electronic health records (EHRs) are increasingly being implemented in healthcare organizations but little attention has been paid to the degree to which nurses as end-users will accept these systems and subsequently use them. Objectives: To explore nurses’ perceptions of usefulness and ease-of-use of EHRs. The relationship between these constructs was examined, and its predictors were studied. Method: A national exploratory study was conducted with 1539 nurses from 15 randomly selected hospitals, representative of different regions and healthcare sectors in Jordan. Data were collected using a self-administered questionnaire, which was based on the Technology Acceptance Model. Correlations and linear multiple regression were utilized to analyze the data. Results: Jordanian nurses demonstrated a positive perception of the usefulness and ease-of-use of EHRs, and subsequently accepted the technology. Significant positive correlations were found between these two constructs. The variables that predict usefulness were the gender, professional rank, EHR experience, and computer skills of the nurses. The perceived ease-of-use was affected by nursing and EHR experience, and computers skills. Conclusion: This study adds to the growing body of knowledge on issues related to the acceptance of technology in the health informatics field, focusing on nurses’ acceptance of EHRs.

Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients

PurposeTo evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. MethodsWe conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. ResultsThe degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (p<0.05). When questioned specifically about EHR satisfaction, resident physicians responded “good” and “excellent” to a greater extent than assistant physicians (p=0.002). ConclusionsOur results reinforce the idea that the EHR introduction in a clinical setting should be preceded by careful planning to improve physician’s adherence to the use of EHR. Patients do not seem to notice much difference to the quality of the consultation done using paper or EHR. It became clear after the third evaluation with the physicians that the younger (residents and some preceptors) perceived the advantages of the EHR more than the older physicians. Resident physicians use the EHR more and are more satisfied with it.

EHR acceptance among Austrian resident doctors

Information Technology (IT) acceptance research has shown that user acceptance is a critical factor for successful IT implementations. Therefore, the success of Electronic Health Record (EHR) systems is largely influenced by the acceptance levels of physicians and their intention to use the system in their daily work. In order to get a better understanding of factors affecting physicians’ acceptance of EHR systems, the effects of the determinants social influence, health IT (HIT) experience, and privacy concerns were investigated. The study presents results from a nationwide survey of Austrian general practitioners and specialists in private practices. To examine the extent to which the factors influence acceptance levels among Austrian physicians, the presented research uses a modified Technology Acceptance Model (TAM) approach. The model was tested using structural equation modeling (SEM) and mediation analyses. According to the results, the presented model is a suitable instrument to explain physicians’ acceptance of EHR systems. As expected, social influence, HIT experience, and privacy concerns had a significant effect on the perceived usefulness of EHR systems, which in turn had an impact on a favorable attitude as well as the intention to use such a system.

Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes

Electronic Health Record (EHR) Systems have been adopted by healthcare organizations for documentation of patient care. Often these information systems are embedded in mobile nurse stations. As part of assessing the impact of this technology it is important to determine the effect it has on charting compliance and user acceptance. Data were collected at a medical center in Taiwan in two stages. The first stage involved use of a 28-item medical review tool to measure charting compliance in 99 charts before and after implementation of the EHR system. In stage two, a survey was conducted with 709 nurse users to determine their level of mobile EHR acceptance 3 months after this documentation technology was initiated. Results demonstrated that EHR significantly improved documentation compliance in standardized data entry format (name, date, time), abbreviation, content correction/revision, patient care needs, and care goals. Analysis of data from the five categories of a user acceptance survey revealed the following results (based on a 4-point Likert scale): patient care (2.92), nursing efficiency (2.78), education and training (2.98), usability (2.61), and usage benefits (2.87). The study concluded that use of mobile nurse stations with EHR can improve documentation compliance and that although frequent system downtime needs improvement, nurses generally have positive attitudes toward this technology application.

The Role of Perceived Usefulness and Attitude on Electronic Health Record Acceptance

Information and communications technologies are a significant component of the healthcare domain, and electronic health records play a major role in it. Therefore, it is important that they are accepted en masse by healthcare professionals. How healthcare professionals perceive the usefulness of electronic health records and their attitudes towards them have been shown to have significant effects on the overall acceptance in many healthcare systems around the world. This paper investigates the role of perceived usefulness and attitude on the intention to use electronic health records by future healthcare professionals using polynomial regression with response surface analysis. Results show that the relationships between these variables are more complex than predicted in prior research. The paper concludes that the properties of the above determinants must be further investigated to clearly understand: (i) their role in predicting the intention to use electronic health records; and (ii) in designing systems that are better adopted by healthcare professionals of the future.

A Clinician’s Report of the Unintended Consequences of Electronic Health Records

ABSTRACT Electronic health records (EHRs) are complex. Clinicians must interact with patient data, order entry, decision support, reporting services, messaging programs, administrative data, and many other services. These services require user input and decision making, known as user interactions, between clinician and the EHR. EHRs have features designed to facilitate users' interactions, such as alerts, reminders, keyboard shortcuts, and mouse click menus. These features can lead to unintended consequences, which combine with user interactions, thus making the EHR complicated and difficult to use. Awareness of user interactions and the unintended consequences will improve EHR design and lead to greater clinician acceptance of EHRs. INTRODUCTION The future of patient charts and information is in the electronic health record (EHR). The world of EHRs is upon us all. Just because we switch from paper to electronic records does not mean it is without its' mishaps. There are a number of things that have changed with electronic implementation of paper charts. Paper charts are a repository of patient information. Clerical, administrative, scheduling, billing, and messaging are not found in paper charts. The advent of the electronic chart frees data from isolated sections, allowing them to be combined into one single chart, the EHR, which not only encompasses patient data, but a myriad of other services that are not always familiar to the clinician. The EHR enables patient data to be combined with other services, thus making it a complete record of the patient. The EHR can contain clerical, administrative, billing and ancillary service information. Labs, x-ray, and diagnostic services can all be included. One of the main benefits of the EHR is a messaging system, where clinicians involved with the patient can be contacted simply by using the integrated messaging system. Clinical decision support (CDS) allows best practice recommendations to be fully integrated with the individual patient, with alerts, reminders and individually tailored recommendations made to clinicians These new services make the transition from a single patient chart to electronic records conceptually difficult for clinicians. Shifting from isolated patient data to a fully-integrated, complex, electronic records system can be difficult to comprehend for technology un-savvy clinicians. Not only does the basic model of a patient chart become fully integrated into other services, but the move from paper to electronic is--in and of itself--difficult as well. A basic understanding of the conceptual (chart) changes is necessary to understand why there are so many unintended consequences when an EHR is designed and implemented. I want to offer a view of the most common unintended consequences found in EHR design. They are divided into two categories, those that are directly related to the EHR and those that are indirectly related to the EHR. These consequences are events that occur as a direct result of EHR features that were originally designed to augment and supplement the EHR, but instead have led to events, such as: * Alert fatigue * Click frustration * Keyboard chaos * Mouse madness * Guessing game (aka Synonyms) * Connect-the-dots There are also a number of system issues that are indirectly related to the EHR; nonetheless, they also lead to unintended consequences, for example: * Security time-outs * Password nonsense * Clerking * Information overload * Visual cues While there are many types of unintended consequences, the focus of this article will be on the direct and indirect items mentioned. Knowing why these events occur can lead to a better understanding as to why clinicians do not always readily embrace the EHR. Unintended consequences can be found in every facet of the EHR, from administrative and billing, to patient care and ancillary services, this article is written from the clinician's perspective. …

Electronic health record acceptance by physicians: Testing an integrated theoretical model

ObjectiveSeveral countries are in the process of implementing an Electronic Health Record (EHR), but limited physicians’ acceptance of this technology presents a serious threat to its successful implementation. The aim of this study was to identify the main determinants of physician acceptance of EHR in a sample of general practitioners and specialists of the Province of Quebec (Canada). MethodsWe sent an electronic questionnaire to physician members of the Quebec Medical Association. We tested four theoretical models (Technology acceptance model (TAM), Extended TAM, Psychosocial Model, and Integrated Model) using path analysis and multiple linear regression analysis in order to identify the main determinants of physicians’ intention to use the EHR. We evaluated the modifying effect of sociodemographic characteristics using multi-group analysis of structural weights invariance. ResultsA total of 157 questionnaires were returned. The four models performed well and explained between 44% and 55% of the variance in physicians’ intention to use the EHR. The Integrated model performed the best and showed that perceived ease of use, professional norm, social norm, and demonstrability of the results are the strongest predictors of physicians’ intention to use the EHR. Age, gender, previous experience and specialty modified the association between those determinants and intention. ConclusionsThe proposed integrated theoretical model is useful in identifying which factors could motivate physicians from different backgrounds to use the EHR. Physicians who perceive the EHR to be easy to use, coherent with their professional norms, supported by their peers and patients, and able to demonstrate tangible results are more likely to accept this technology. Age, gender, specialty and experience should also be taken into account when developing EHR implementation strategies targeting physicians.

Electronic Health Record Acceptance: A Descriptive Study in Zahedan, Southeast Iran

Electronic Health Record (EHR) is a necessary tool for providing uninterrupted flow of information about the health of population. The role of physicians cannot be overemphasized in the implementation of EHR; therefore, the purpose of this study is to determine the physician’s attitude towards the acceptance of EHR project. In this regard, a descriptive analytical study was carried out in 2011; however, sampling was done by convenience sampling method that includes 70 physicians of public hospitals affiliated to Zahedan University of Medical Sciences. Data collection was made through a self-administered questionnaire and data processing was done using descriptive statistics and analysed by Oneway ANOVA and One-sample t-test. The factors affecting acceptance of electronic health record by physicians were determined as follows: management support 4.01 ± 0.60, physician involvement 4.06 ± 0.51, adequate training 4.04 ± 0.51, physician autonomy 3.20 ± 0.61, doctor-patient relationship 2.33 ± 0.82, perceived usefulness 3.91 ± 0.46 and attitude about electronic health record acceptance 4.03 ± 0.46. Physician’s attitude towards Electronic Health Record acceptance was determined in optimal level. In order to facilitate successful adoption of electronic health record, involvement of physicians would be essentially required during the EHR designing, implementation and usage phase.

Modeling Security in Acceptance of Electronic Health Record Systems

Transactional systems are ubiquitous in most industries; however, healthcare organizations continue to slowly diffuse Electronic Health Record (EHR) systems. This research integrates security features such as biometrics for authentication purposes, multiple access connections, and single sign-on systems into the Technology Acceptance Model to explore whether these features might improve user acceptance of EHR. Security potentially affects user perceptions of ease of use and usefulness, improving acceptance of EHR systems. This work contributes to the literature by exploring whether security features are important in shaping health care worker attitudes towards EHR systems.

“Why the Hell Do We Need Electronic Health Records?”

Progress in the medical sciences, together with related technologies, in the past has led to higher specialization and has created a strong need to exchange health information across institutional borders. The concept of electronic health records (EHR) was introduced to fulfill these needs. Remarkably, many EHR introduction projects ran into trouble, not least because they lacked the acceptance of EHR among physicians. Negative emotions, such as anxiety and fear due to a lack of information, may cause change barriers and hamper physicians' acceptance of such projects. The goal of this study was to gain deeper insight into the negative emotions related to the intended implementation of a mandatory national electronic health record system (called ELGA) in Austria among physicians in private practice. Qualitative, problem-centered interviews were conducted with eight physicians in private practice in the capital region of Tyrol. The methods of qualitative content analysis were used to analyze the data. Three hundred and twenty-eight passages in the interviews were selected, annotated, and paraphrased. These passages were assigned to 139 different primary categories. Finally, 18 main categories in the form of statements were derived. They were correlated and a theoretical model was formed to explain the genesis of the detected fears and anxiety related to the ELGA project. The results show that the physicians feel uninformed and snubbed. They fear unknown changes, increased costs, as well as workload and surveillance without obtaining any advantages from using electronic health records in their daily practice. Impartial information campaigns that are tailored to the physicians' needs and questions as along with a comprehensive cost-benefit analysis could benefit the physicians' opinion of EHRs.