A resistance model of electronic medical records adoption in Taiwanese hospitals: A multi-method approach

Abstract

The EMR adoption work in Taiwanese hospitals is led by the Ministry of Health and Welfare (MOHW). According to van Velthoven et al. (2016) [1], all large medical centers (>1,000 beds), approximately 70% of regional hospitals and almost 30% of district hospitals use an EMR system to date. The highEMR adoption rate can be attributed to the Taiwanese National Health Insurance scheme (NHIs) [2]. There are 80% of the hospital incomes from the Bureau of National Health Insurance, and 20% from the registration fees [3]. Due to this reason, the adoption of EMRs is considered as one of the essential requirements to link the network with the NHI system for claiming patient consultation fees and medical expensesin daily operation.EMR is a longitudinal electronic record of patient health information generated by one or more encounters in a care delivery setting [4]; therefore, healthcare professionals' contribution plays an essential role in the process of EMR adoption. However, following financial issues and technical issues (e.g., hardly find an adequate system), the healthcare professionals' resistance, one of the human-related factors, is also a key barrier to the success of EMR adoption [5,6]. The reasons of healthcare professional resistance to the EMR adoption not onlyinclude workload increase with no extra compensation, anxiety to IT, lack of time or ability to learn new IT, inertia to the change and etc., but unjust management practices in work and information distribution also play an important part. Thus, two research questions guide this paper: (1) what are the issues that lead to healthcare professionals' resistance to the adoption of EMR system; (2) what are the elements that a hospital needs to consider to mitigate the resistance behavior?We attempt to address the issue by adopting equity theory and psychological reactance theory to discuss the situation of healthcare professional resistance to EMR adoption in the hospital. Equity theory claims that equality of the management practice is critical to maintainemployer-employee relationships [7]. Inequality treatment often causes unfavorable feelings; therefore, we firstly adopt the concept of perceived unmet promise [8,9], which focuses on the equality of reciprocal obligations between the hospital and its employees, and four key aspects (individual, system, organization, and process) will be evaluated. Secondly, organizational justice [10] is also adopted to evaluate the hospital practice in equality of distributive, procedural, interpersonal, and informational justice. Besides, psychological reactance theory suggests that one unfavorable feeling will result in negative behaviors such as resistance behaviors [11]. Wetherefore infer that healthcare professionals expect to be treated equally when adopting the EMRs to the working place.If the hospital fails to do so, an unfavorable perception will be generated, such as perceived contract breach (PCB), leading to resistance behaviors to the EMR adoption work. Moreover, Rivard and Lapointe [12] mentioned that the r...