Acceptance Of Electronic Medical Record Research Articles

Allied health professionals’ experiences and lessons learned in response to a big bang electronic medical record implementation: A prospective observational study

IntroductionThere is limited evidence describing the impact of electronic medical record (EMR) implementation on allied health professionals’ acceptance, expectations, and work efficiencies. This study aims to: A) identify clinician expectations and factors that influence EMR acceptance; B) evaluate perceived usability, technology proficiency and satisfaction; and C) assess the impact of EMR big bang implementation on allied health workflows at three Australian tertiary hospitals. MethodsRepeated measures study pre and six-months post EMR implementation. User acceptance was evaluated with online surveys: Unified Theory of Acceptance and Use of Technology (pre), System Usability Scale and open-ended questions (post). A four-hour time-motion study evaluated changes in allied health inpatient workflows. ResultsSurveys were completed by 224 allied health clinicians (47% response rate) pre, and 196 (41%) post-implementation. Pre-implementation, 96% of respondents felt using the EMR was a good idea and they would find it useful. Six-months post-implementation 88% liked interacting with the EMR. 64% found it easy to use and most didn’t require technical support (78%). While 68% of participants felt very confident, 51% believed they were not using the EMR’s full potential.Post-implementation half of participants agreed significant upskilling was required and that EMR workflows were not quick to learn. Live demonstrations were considered the most helpful activity prior to training; hands-on practice in the training environment and superuser support were invaluable preparing for and during go-live. Time-motion data (mean difference (MD) (95% CI)) indicated that following implementation participants spent 2.27% (−3.53, 8.09, p = 0.731) more time in clinical tasks. More time was spent performing clinical documentation (5.39% (1.98, 8.8), p = 0.002). ConclusionsMany factors can impact allied health professional’s adoption of a new EMR. Institution-wide, simultaneous big bang EMR implementation, with strong allied health leadership, can lead to positive benefits, particularly in user experience. Ongoing evaluation will drive future improvements.

Modelling the Acceptance and Use of Electronic Medical Records from Patients’ Point of View: Evidence from Saudi Arabia

Background: The employment of IT in healthcare reflects a need to meet the increasing demands of patients and to upgrade the quality and productivity of the provided services. However, the literature demonstrates many failures in systems and IT technology implementation. One of the reasons behind these failures is users’ resistance. The ministry of health (MOH) in Saudi Arabia (SA) has prioritized the embracing of new technologies that could improve the healthcare services, such as electronic medical record (EMR) systems. On the other hand, studies that address the acceptance and use of hospital information systems (HIS) and EMRs in SA from patients’ standpoint are scarce. The aim of this study was to explore patients’ acceptance of an EMR system by proposing a model adapted from the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT).
 
 Methods: An online questionnaire was used where questions were based on the proposed model constructs (facilitating conditions (FC), perceived ease of use (PEOU), perceived usefulness (PU), attitude (ATT), and behavioral intention (BI)). 116 patients responded to the questionnaire. The model was then tested to identify the factors that affect patients’ intention to use the online services of the EMR.
 
 Results: The analysis of the research model suggested that (1) FCs influenced the degree of system’s PEOU. (2) PEOU affected the EMR’s PU. (3) PU affected patients’ ATT toward using the EMR. (4) A positive effect is found between ATT and BI to use EMR.
 
 Conclusion: The study has implications for healthcare IT acceptance research and efforts in SA, as to date patients’ perspectives have received little attention. The research also makes a theoretical contribution as it validated the proposed model.

Effects of privacy and security on the acceptance and usage of EMR: The mediating role of trust on the basis of multiple perspectives

Malaysian public hospitals apply an electronic medical record (EMR) system. However, health-care professionals are facing several difficulties in trusting the EMR system in Malaysia. Studies that have addressed EMR acceptance, particularly its application in the context of privacy and security concerns on the basis of a multi-criteria perspective in Malaysian hospitals, are still lacking. This research proposed a new model testing the individual, security, and privacy factors affecting EMR acceptance and the role of trust as a mediator. The suggested model was developed on the basis of multiple perspectives targeting the health-care professionals in Malaysia. A conceptual model was developed on the basis of unified theory of acceptance and use of technology UTAUT2 to explore the relationship between individual, privacy, and security factors and the acceptance of the EMR system and the role of trust as a mediating construct. A total of 375 usable questionnaires were collected from the study population. Structural equation modeling was employed to analyze data and test the fit of the model. Two constructs, namely, security and individual, have positive influences on EMR acceptance and use. The privacy construct shows a negative effect on EMR acceptance and use. Trust mediates the effects of security, privacy, and individual factors partially, which, in turn, influences the behavioral intention to use and adopt EMR.

The Differing Effect of Gender and Clinical Specialty on Physicians' Intention to Use Electronic Medical Record.

The use of electronic medical record (EMR) is anticipated to bring benefits for patients, physicians, and organizations. But limited physicians' acceptance of EMR presents a serious threat to its effective implementation. The current study incorporates technology acceptance model (TAM) with two antecedents, gender, and clinical specialty and one context-specific factor, financial incentives, to identify the factors that influence physicians' intention to use EMR in Taiwan. The survey methodology was used to collect data from the physicians, working in the regional hospital that had implemented EMR system. A total of 119 out of 213 questionnaires returned in a response rate of 56%. But four responses were considered ineffective due to missing values. The structural equation modeling (SEM) technique was employed to analyze the research framework. The partial least squares (PLS) regression indicated that three factors perceived usefulness, financial incentives, and attitude toward using EMR significantly affect physicians' intention. But concerning perceived ease of use (PEOU), an insignificant path coefficient was reported. Additionally, regression analysis showed gender, and clinical specialty positively influenced physicians' intention to use EMR. The proposed research framework contributes to the conclusive explanation for interpreting physicians' intention to use EMR. Physicians generally have a higher level of computer literacy. Therefore, the factor of PEOU could not be critical regarding adopting new health information technology (HIT). This study also brings perspectives from the gender, and clinical differences have primarily been missing in the literature of the physicians' intention to use HIT. In doing so, it infers how gender, and clinical specialty, may complement (and in some instances, reinforce) the influence of technological and attitudinal factors of HIT use. Thus, health care providers must take these factors into consideration in the development and validation of the theories regarding the intention to use EMR.

Modeling predictors of acceptance and use of electronic medical record system in a resource limited setting: Using modified UTAUT model

Abstract Background The growing application of electronic medical record systems in non-industrialized nations has marked an important area of interest to determine factors associated with acceptance and use of these systems. There have been only a few studies done in this area, which are not yet sufficient to fully understand the antecedents in resource limited settings. Objectives The aim of this study is to introduce a modified UTAUT model and show its applicability to assess acceptance and use of electronic medical record (EMR) systems in resource limited settings. Method An institutional based cross-sectional study was conducted to assess acceptance of the EMR system among potential front-line users (doctors and nurses) in three selected health facilities. Descriptive analysis was performed to describe the characteristics of participants using structural equation modeling (SEM) to explain the extent of the relationship among latent variables. Result From a total of 423 participants, 95.6% (405) responded from Jun 14 to August 28, 2018 and nine other participants’ data were excluded for being outliers. The majority of the participants were male 64.9% (257) and most of the participants had a work experience of less than five years 52.7% (209). All constructs exhibited an acceptable level of reliability and validity with Cα and CR > 0.7 and AVE >0.5. Although self-efficacy has a surprisingly insignificant effect on the participants' attitude to use the EMR system, Performance expectancy, social influence and effort expectancy demonstrated significant influence with β = 0.278, P Conclusion With 40.2% of the variance in intention to use the EMR system, and 58.5% of the variance in EMR use explained by this model, it could be helpful for determining factors associated with EMR acceptance and use.

Electronic medical record systems: decision support examination framework for individual, security and privacy concerns using multi-perspective analysis

Electronic medical record (EMR) is currently a popular topic in e-health. EMR includes the health-related information of patients and forms the main factor of e-health applications. Moreover, EMR contains the legal records that are created in the medical centre and ambulatory environments. These records serve as the data source for electronic health record. Although hospitals utilise the EMR system, healthcare professionals experience difficultly in trusting this system. Studies devoted to EMR acceptance in hospitals are lacking, particularly those on the EMR system in the contexts of privacy and security concerns based on multi-criteria perspective. Thus, the current study proposes a decision support examination framework on how individual, security and privacy determinants influence the acceptance and use of EMR. The proposed framework is based on a multi-criteria perspective derived from healthcare professionals in Malaysia as frame of reference. The framework comprises four phases. The sub-factors of individual, security and privacy determinants were investigated in the two initial phases. Thereafter, the sub-factors were identified with uniform multi-criteria perspective to establish a decision matrix. The decision matrix used individual uniform as basis to cluster the sub-factors and user perspectives. Subsequently, a new ‘multi-criteria decision-making (MCDM) approach’ was adopted. Integrated technique for order of preference by similarity (TOPSIS) and analytic hierarchy process (AHP) were used as bases in employing the MCDM approach to rank each group of factors. K-means clustering was also applied to identify the critical factors in each group. Healthcare professionals in Malaysia were selected as respondents and 100 questionnaires were distributed to those employed in 5 Malaysian public hospitals. A conceptual model adapted from Unified theory of acceptance and use of technology 2 (UTAUT2) was employed to clarify the connection between individual, privacy and security determinants and EMR system acceptance and use in the selected context. After collecting the data sets (363), structural equation modelling was used to analyse data related to EMR acceptance and use. Results are as follows. (1) Five determinants (i.e. data integrity, confidentiality, non-repudiation, facilitating conditions and effort expectancy) exerted an explicit and important positive effect on EMR acceptance and use. (2) Three determinants (i.e. unauthorised, error and secondary use) exerted a direct and significant negative effect on EMR acceptance and use. (3) Three other determinants (i.e. authentication, performance expectancy and habit) insignificantly affected the behavioural intention of healthcare experts in Malaysia to use EMR.

Assessment of factors influencing nurses acceptance of electronic medical record in a Saudi Arabia hospital

Abstract Background We aimed to explore the acceptance level of electronic medical records (EMR) by the nursing staff and understand their perspective on it. Methods The target population included all nurses working in Imam Abdulrahman Al Faisal Hospital at the National Guards Health Affairs (NGHA), Dammam, Saudi Arabia using EMR in their clinical practice. A questionnaire was developed to determine the respondent's opinion for achieving the study objectives. A total of 230 questionnaires were distributed and 153 questionnaires were completed and returned with 66.5% response rate. Results The findings state that there is a strong positive correlation between perceived usefulness and perceived ease of use resulting in a positive effect on nurses' acceptance. The nurses in National Guards Health Affairs (NGHA) are willing to use EMR to improve the quality of patient care. Therefore, their willingness to learn the system and be less resistant to change will be possible by introducing a more user-friendly system, which will ultimately increase their level of acceptance. Conclusions User demographic characteristics, top management and IT support and system quality are important in predicting nursing personnel's acceptance toward EMR. These findings can be used as guidance for hospital management to address the nurses' concerns.

Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians.

Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information. This study aimed to understand physicians' needs regarding time-oriented patient information in EMRs in clinical practice. The reliability and validity of the items in the questionnaire were evaluated in 87 physicians at a national university hospital. Internal consistency was satisfactory (Cronbach alpha coefficient, 0.87). Four dimensions were identified in exploratory factor analysis. Correlations between the 4 dimensions supported the construct validity of the items. Scores of time-oriented patients' medical history in the 4 dimensions showed a significant association with physician age. Based on confirmatory factor analysis, associations were significant and positive (P<.001). In terms of the needs of physicians regarding time-oriented patient information in EMRs, both time-oriented treatment results followed by time-oriented team information had significant positive associations. Our study suggests that 4 specific time-oriented patient information factors in EMRs are needed by physicians. Exploring physicians' needs regarding patient-specific time-oriented information may provide a better understanding of the barriers facing the adoption and use of EMRs (eg, decision-making and practice safety concerns) and lead to better acceptance of EMRs in physicians' clinical practices.

105: EMR Readiness Assessment at a Tertiary Care Paediatric Hospital

Electronic medical record (EMR) use is increasing with 57% of physicians using an EMR in 2013. Successful adoption of an EMR is dependent on many factors including the type, practice setting, interface design and usability. Many providers express discomfort and concern in adapting from a paper-based documentation system to an EMR. At our institution we completed an assessment of our readiness to implement an ambulatory care EMR. To understand provider concerns In preparation for the EMR implementation and to respond to their needs to increase implementation success. An EMR Readiness Assessment (RA) and Technical Adoption questionnaire was distributed electronically to end users through Electronic Data Capture software (Version 5.6.1 – © 2013 Vanderbilt University). The questions were derived from three sources previously validated in a physician based healthcare setting; a questionnaire used by Morton (2008) to determine factors that contribute to physician EMR acceptance; an Organizational RA questionnaire for targeted follow-up; and a Benefits Evaluation and Technology Acceptance Model (Davis, 1989; Chutter, 2009). All three sources were compared to eliminate duplication. The final questionnaire was pilot tested for face-validity. Participation was voluntary. The questionnaire was administered for three consecutive weeks prior to the EMR go-live; two separate email reminders were sent. A total of 167 (48%) providers completed the RA questionnaire; 21% were <30 years and 60% 30 to 50 years of age; 57% had worked in health care for >10 years. 99% used a computer as part of their daily work with 59% stating general and 37% advanced proficiency. Overall attitude regarding the EMR is given in the table. We have seen provider anticipation, engagement and acceptance of the EMR implementation. Providers are aware of the need for an EMR and the benefits for patient care. The majority of providers use computers in their daily work and are proficient in its use. We plan to perform a post go-live RA questionnaire to ensure ongoing provider engagement.

Users′ acceptance and attitude in regarding electronic medical record at central polyclinic of oil industry in Isfahan, Iran

Introduction:Simultaneous with the rapid changes in the technology and information systems, hospitals interest in using them. One of the most common systems in hospitals is electronic medical record (EMR) whose one of uses is providing better health care quality via health information technology. Prior to its use, attempts should be put to identifying factors affecting the acceptance, attitude and utilizing of this technology. The current article aimed to study the effective factors of EMR acceptance by technology acceptance model (TAM) at central polyclinic of Oil Industry in Isfahan.Materials and Methods:This was a practical, descriptive and regression study. The population research were all EMR users at polyclinic of Oil Industry in 2012 and its sampling was simple random with 62 users. The tool of data collection was a research-made questionnaire based on TAM. The validity of questionnaire has been assigned through the strategy of content validity and health information technology experts’ views and its reliability by test-retest.Findings:The system users have positive attitude toward using EMR (56.6%). Also, users are not very satisfied with effective external (38.14%) and behavioral factors (47.8%) upon using the system. Perceived ease-of-use (PEU) and perceived usefulness (PU) were at a good level.Conclusion:Lack of relative satisfaction with using of EMR derives from factors such as appearance, screen, data and information quality and terminology. In this study, it is suggested to improve the system and the efficiency of the users through software’ external factors development. So that PEU and users’ attitude to be changed and moved in positive manner.

E-Prescribing: History, Issues, Potential

Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform.

Management Issues in Healthcare Information Technology

Management Issues in Healthcare Information Technology

Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

BackgroundThe main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.MethodsA systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information.ResultsThe study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers.ConclusionsDespite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.

EXAMINING HEALTHCARE PROFESSIONALS' ACCEPTANCE OF ELECTRONIC MEDICAL RECORDS USING UTAUT

With the growing demand for digital information in health care, the electronic medical record (EMR) represents the foundation of health information technology. It is essential, however, in an industry still largely dominated by paper-based records, that such systems be accepted and used. This research evaluates registered nurses’, certified nurse practitioners and physician assistants’ acceptance of EMR’s as a means to predict, define and enhance use. The research utilizes the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical model, along with the Partial Least Square (PLS) analysis to estimate the variance. Overall, the findings indicate that UTAUT is able to provide a reasonable assessment of health care professionals’ acceptance of EMR’s with social influence a significant determinant of intention and use.

Electronic Medical Records: Are Physicians Ready?

The use of electronic medical records (EMR) in healthcare organizations will require substantial changes in the way physicians and their staff provide patient care. This study is the first part of a larger study assessing factors that influence successful implementation of EMR in ambulatory care settings. The purposes of this study were to identify specific attitudes or factors that should be targeted before implementating an EMR project, and demonstrate empirical support for a model of perceived usefulness of EMR. We found that computer experience, computer anxiety, and perceptions of organizational support predict the degree to which physicians and mid-level practitioners view the EMR effort positively. Strategies for the successful management of EMR implementation include engaging the physicians and practitioners in computer activities prior to implementation and providing strong organizational support before and during the redesign effort. Acceptance of EMR by physicians and their support staff is essential if computerization is to be successful, yet anecdotal reports of resistance and negative attitudes are frequently reported. Empirical studies indicate that physicians have not yet embraced this technology. As part of strategic planning and deployment of a computerized patient record, attitudes of end-users must be assessed. Using an integrative framework from the job design literature and management information sciences, we propose that multiple factors influence attitudes toward EMR, offer a conceptual model of end-user acceptance, and present findings from an empirical test of our model.