What do physicians want? Information technology acceptance and usage by healthcare professionals.

摘要

This study builds on the theory of planned behavior, institutional and innovation diffusion theories to investigate physicians' responses to introduction of electronic medical records (EMR) in large healthcare organizations. Using a case study methodology, we show that physicians' attitudes towards using EMR are influenced by their perceptions of EMR complexity, relative advantage, compatibility with professional beliefs and individual predisposition to change. Specifically, we found that EMR usability characteristics such as system interface, "navigation," "search" and "speed" are major dimensions underlying physicians' perceptions of EMR complexity. To the extent that navigating and searching for clinical results are seen as difficult, physicians' perceptions of the complexity of using EMR are enhanced, with the result of physicians forming more negative attitudes towards EMR and using EMR less. Accessibility to EMR (i.e. logging in) and availability of hardware are two emergent constructs. These factors are immediate barriers for physicians not using EMR or using EMR minimally. At the same time, these barriers contribute to impacting physicians' perceptions that EMR is difficult to use and disadvantageous (i.e. time inefficient) compared to the paper chart. Results also show that most EMR usage at Alpha is rather "shallow." Physicians tend to use data-retrieval EMR minimally, mainly to supplement the paper chart. The availability of this "competing artifact," that is much easier to use and conveniently located near a patient's room limits the extent to which physicians use EMR at Alpha. Use of an imaging EMR system (EMR3) is more committed. EMR3 is used to replace the "old way" of accessing films. Lack of accessibility and hardware barriers, the relative advantage of EMR3 and other system usability considerations contribute to physicians using this system more faithfully. As regards the question "what do physicians want?" it seems that physicians want a system that is easy to access and simple to use but most importantly, a system that they can directly identify with, an EMR that is personally relevant. In order to promote a "deeper" level of EMR usage, the benefits of EMR need to be emphasized to physicians while any potential costs or barriers reduced or eliminated.