Intention to Use and Use Behaviours of Electronic Health Record (eHR) among Physicians, Nurses and Healthcare Assistants

Abstract

Since World Health Assembly encouraged countries to create their own eHealth plans in 2005, there has been an increasing interest in using information technology (IT) for educating medical staff, conducting research, treating patients, monitoring public health and tracking several types of diseases [1]. Electronic health record (eHR), one of the components of eHealth is expected to reduce cost, eradicate medical waste, increase accessibility of medical records and improve quality of healthcare outcomes [2]. Some developed countries such as United States, United Kingdom, Canada, Germany, Australia, Netherland and New Zealand have successfully implemented a great level of ambulatory eHR; however, lack of efforts and strategies were found with respect to Health Information Exchange (HIE) and impatient eHR [2]. HIE is growing opportunity to let medical staff access comprehensive medical records of their patients before making appropriate medical decisions about them. It also helps timely access to a patient records that required for medical team, improving patient safety and reducing cost of care.

There are several incentives taken to enhance HIE. One of the most current and exciting attempt involves a great incentive via setting public private partnership and implementing county wide electronic health records available for both public and private health organizations. The idea of exchanging medical records brought several opportunities to reduce repeating of medical tests and improve patient safety when patients shift between public and private medical organizations. An example of HIE in this study provides a top-down approach where Hong Kong Government has actively taken incentives to centrally store and share electronic health records for healthcare purposes using eHRSS in public and private sectors [3]. The eHRSS was launched in March 2016 with the aim of public and private sectors to access and share patients' eHR for healthcare purposes. As at early-November 2017, over 610,000 patients have registered to the system and over 1,400 Healthcare Providers (HCPs) (including the Hospital Authority (HA), the Department of Health (DH) and all 12 local private hospitals) have already joined the system. The registered HCPs have created more than 43,000 eHRSS user accounts. In early stage of eHR, access to the eHRSS has only abled for doctors. Later, nurses (including midwives) and dentists have started using the system since September 2017.

Users’ reactions for IT have been assessed in different industries other than healthcare. The Unified Theory of Acceptance and Use of Technology (UTAUT) is most current model for assessing IT acceptance and adoption after launching of Technology Acceptance Model (TAM) in 1980s. Unlikely to other industries, users’ reactions to such eHR technologies haven’t been assessed and evaluated appropriately. Although the existing literature has focused on design and implementation of those eHR technologies [4-7], little attention was paid to how healthcare staff find those available technologies useful or easy to use. The fit between healthcare staff and proposed IT is depend on users to accept, reject, use and misuse of a technology. If healthcare staff find proposed IT useful or easy to use, then an eHR would provide a great chance to improve quality and safety in healthcare such as reducing errors (medical incidents), saving resources (less repeated test), providing secure and timely access to comprehensive patient records for both public and private providers [8]. This study is currently at data entry and data analysis process. It aims to identify significant constructs that display key roles in the eHR acceptance and adoption at both public and private healthcare institutions. It will also provide feedback driven from using the eHR among physicians and nurses. For further development and enhancement of the EHR, this study will highlight the perceived strengths and weaknesses of the newly implemented system (the eHRSS) in Hong KongSAR.