Examining the Acceptance of an Integrated Electronic Health Records System: Insights from a Repeated Cross-Sectional Design

Abstract

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.