Background and purpose

Hospital staff’s acceptance of an integrated Electronic Health Records system (EHR) is a critical success factor to exploit the benefits EHRs can offer. This study employs a repeated cross-sectional design to differentiate between the enablers and barriers of EHR acceptance prior to EHR implementation and those that arise over time by testing a theoretical model specifically tailored to the EHR context.

Methods

A repeated cross-sectional design, consisting of one measurement of staff’s acceptance before and two after EHR implementation, was employed in a Belgian hospital. To test the theoretical model, partial least squares structural equation modelling (PLS-SEM) was used. Furthermore, partial least squares multigroup analyses (PLS-MGA) and permutation tests were applied to examine whether the relations in the model vary significantly over time.

Results

The formulated model explains up to 80 % of the variance in hospital staff’s attitude towards the EHR. The extent to which the EHR leads to administrative simplification outperforms the core technology acceptance variables. Furthermore, support was found for the significant role of implementation factors (i.e. communication quality and training) and prior IT experiences in explaining EHR acceptance. Finally, the results show significant evolutions in path coefficients over time. An important trade-off between effort expectancy and performance expectancy was revealed, meaning effort expectancy is the most important determinant of hospital staff’s attitude towards the EHR, but once the EHR has been implemented performance expectancy becomes more important.

Conclusions

The results of testing the hypothesized model reveal the importance of taking into account hospital staff’s perception of the extent to which the EHR generates administrative simplification, a combination of implementation factors, and attitude towards technology in general when assessing the acceptance of an EHR. Moreover, the results highlight the importance of conducting repeated cross-sectional or longitudinal technology acceptance research as relations between core variables vary significantly over time, which implies hospital management and healthcare technology providers should adjust their policy throughout the various implementation stages.

中文翻译：

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检验是否接受集成电子病历系统：重复横截面设计的见解

背景和目的

医院工作人员接受集成的电子病历系统（EHR）是成功利用EHR可以提供的好处的关键成功因素。这项研究采用重复的横截面设计，以区分在实施EHR之前接受EHR的推动力和障碍，以及通过测试专门针对EHR上下文而设计的理论模型随时间推移而出现的推动力和障碍。

方法

比利时一家医院采用了重复的横断面设计，包括在实施EHR之前对员工的接受程度进行的一种测量以及在EHR实施之后对员工接受程度的两种测量。为了测试理论模型，使用了偏最小二乘结构方程模型（PLS-SEM）。此外，使用偏最小二乘多组分析（PLS-MGA）和置换检验来检验模型中的关系是否随时间而显着变化。

结果

制定的模型最多可解释80％的医务人员对电子病历的态度差异。EHR导致行政简化的程度超过了核心技术的接受程度。此外，还发现支持实施因素（即通信质量和培训）以及先前的IT经验在解释EHR接受方面的重要作用。最后，结果表明路径系数随时间发生了显着变化。揭示了预期工作量与预期绩效之间的重要权衡，这意味着预期工作量是医院工作人员对待EHR态度的最重要决定因素，但是一旦实施了EHR，预期绩效就变得更加重要。

结论

假设模型的测试结果表明，在评估电子病历的接受度时，必须考虑医院工作人员对电子病历在多大程度上简化行政管理，实施因素的组合以及对技术的态度的看法。此外，由于核心变量之间的关系随时间而显着变化，因此结果强调进行重复的横截面或纵向技术接受研究的重要性，这意味着医院管理和医疗技术提供商应在各个实施阶段调整其政策。