Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies*

Abstract

This study examines physicians' responses to complex information technologies (IT) in the health care supply chain. We extend individual-level IT adoption models by incorporating a new construct: system accessibility. The main premise of the study is, when faced with a decision between alternate IT systems, individual users tend to select and make use of the technology or system that is most readily accessible. We discuss both physical and logical dimensions of accessibility as they relate to adoption of electronic medical records (EMR). Physical accessibility refers to the availability of computers that can be used to access EMR, while logical accessibility refers to the ease or difficulty of logging into the system. Using data from a survey of 199 physicians practicing in a large U.S. hospital, we show that, when deciding between the paper chart and EMR, accessibility is an important consideration in a physician's decision to use the system. Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use. Logical access also has a direct effect on EMR use intentions. We conclude that accessibility is an important factor that limits acceptance of complex IT such as EMR.

Assessing Hospital Physicians' Acceptance of Clinical Information Systems: A Review of the Relevant Literature

“…The constructs used by Paré, et al (2005) could not be grouped under one of the UTAUTcategories, but are displayed under "other factors". This is not the case for physical access and logical access (Ilie, et al, 2009), which have a large degree of conceptual overlap with, respectively, facilitating conditions and effort expectancy. Therefore, physical and logical access are grouped under these constructs although they were originally not considered by Venkatesh, et al (2003).…”

“…Physicians and nurses are different user types and they use different components of the same system, possibly leading to very different evaluations of the same system (Aarts & Berg, 2006;Lapointe & Rivard, 2005;Sicotte, et al, 2009). Moreover, in many cases and unlike nurses, only a few physicians are directly employed by the hospital (Ilie, Van Slyke, Parikh, & Courtney, 2009), so the hospital management cannot exert much pressure. Physicians, unlike many other IT-users, also have a greater freedom of choice (or professional autonomy) to use or not use a technology (Lapointe & Rivard, 2005;Walter & Lopez, 2008).…”

“…TAM was assessed in four studies and perceived usefulness was identified as a consistent strong predictor of behavioural intention throughout all four studies, while perceived ease of use was of no importance. TAM has been criticised for being too parsimonious as it includes only two beliefs as predictors for behavioural intention (see Figure 1), and remarkably, in all four studies with TAM, the authors either added one or more constructs Ilie, et al, 2009) or compared it to a combination of TAM and TPB which extends TRA in a complementary manner (Chau & Hu, 2001, 2002b. Both resistance to change and logical access (Ilie, et al, 2009) were significant predictors of behavioural intention.…”

“…TAM has been criticised for being too parsimonious as it includes only two beliefs as predictors for behavioural intention (see Figure 1), and remarkably, in all four studies with TAM, the authors either added one or more constructs Ilie, et al, 2009) or compared it to a combination of TAM and TPB which extends TRA in a complementary manner (Chau & Hu, 2001, 2002b. Both resistance to change and logical access (Ilie, et al, 2009) were significant predictors of behavioural intention. Variance explained in behavioural intention was a lot higher in the studies who added a predictor compared to the studies who tested the basic version of TAM (Chau & Hu, 2001, 2002b.…”

“…Nine studies adopted a one-shot approach: they assessed physicians acceptance on one occasion, either while the system was already in use Chang, et al, 2007;Chau & Hu, 2001, 2002a, 2002bGagnon, et al, 2003;Ilie, et al, 2009;Paré, et al, 2005) or pre-implementation . In two studies (Alapetite, et al, 2009; physicians' acceptance was assessed on two occasions: pre-implementation and while the system was in use.…”