J. Med. Internet Res. - A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.

Tópicos

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Resumo

CKGROUND: There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations.OBJECTIVE: We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model.METHODS: We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques.RESULTS: We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers.CONCLUSIONS: Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.

Resumo Limpo

ckground major campaign involv larg expenditur public money increas adopt rate electron health record ehr system canada maxim chanc success effort physician view ehr must address sinc user percept key success implement technolog innovationsobject propos theoret model compris behavior factor either favor ehr adopt use canadian medic practic physician point view ehr percept physician alreadi use ehr system compar use one len modelmethod conduct onlin crosssect survey english french among medic practition across canada data collect physician use ehr use ehr analyz structur equat model sem techniquesresult collect respons ehr user nonus result valid sampl particip respect theoret adopt model explain varianc behavior intent continu use ehr physician alreadi use varianc nonus intent adopt system percept eas use found strongest motiv ehr user total effect percept use eas use key determin nonus total effect respect adopt system user see perceiv overal risk associ ehr adopt major obstacl total effect nonus perceiv risk weak indirect demotiv path sem model show signific differ sampl level general doubt use system p necess system relev job p necess system use p import ehr nonus user percept overal obstacl adopt p system eas use p count ehr user nonusersconclus relat differ percept ehr system adopt use exist physician alreadi use system yet use system maxim chanc success new ehr implement behavior point view general doubt rational system must mitig improv design stress ehr relev physician job provid substanti evid ehr easier use effect nonus might expect

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