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Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics

  • Patient Facing Systems
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Abstract

The health care reform initiative led by the Hong Kong government’s Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients’ health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users’ and organizations’ needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users’ information technology literacy; training and technical support; and social and organizational influences. The factors are interrelated with the others. The adoption factors identified are multifaceted, ranging from technological characteristics, clinician-technology interactions, skills and knowledge, and the user-workflow-technology fit. Other findings, which have been relatively underrepresented in previous studies, contribute unique insights about the influence of work and social environment on the adoption of EMRs, including limited clinic space and the effects of physicians’ decision to use the technology on clinical staffs’ adoption decisions. Potential strategies to address the concerns, overcome adoption barriers, and define relevant policies are discussed.

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Abbreviations

EMR :

Electronic medical record

IT :

Information technology

References

  1. Ahmadian, L., Khajouei, R., Nejad, S. S., Ebrahimzadeh, M., and Nikkar, S. E., Prioritizing barriers to successful implementation of hospital information systems. J. Med. Syst. 38(12):6, 2014. https://doi.org/10.1007/s10916-014-0151-9.

    Article  Google Scholar 

  2. Berg, M., Langenberg, C., vd Berg, I., and Kwakkernaat, J., Considerations for sociotechnical design: Experiences with an electronic patient record in a clinical context. Int. J. Med. Inform. 52(1):243–251, 1998.

    Article  PubMed  CAS  Google Scholar 

  3. Berkowitz, L., Physician adoption strategies. In: Carter, J. H. (Ed.), Electronic health records: a guide for clinicians and administrators. Washington, DC: American College of Physicians, 2008, 249–274.

    Google Scholar 

  4. Boonstra, A., and Broekhuis, M., Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv. Res. 10(1):231, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Boonstra, A., Versluis, A., and Vos, J. F., Implementing electronic health records in hospitals: A systematic literature review. BMC Health Serv. Res. 14(1):370, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chan, F. Y., Sun, D. T., Or, C., and So, H. Y., Feasibility of usability test in human error prone infusion device–a pilot study. Paper presented at the 33rd International Scientific Meeting on Quality and Safety in Health Care, Tokyo, Japan, October 16–19, 2016.

  7. Chao, W. C., Hu, H., Ung, C. O. L., and Cai, Y., Benefits and challenges of electronic health record system on stakeholders: A qualitative study of outpatient physicians. J. Med. Syst. 37(4):6, 2013. https://doi.org/10.1007/s10916-013-9960-5.

    Article  Google Scholar 

  8. Collier, R., National physician survey: EMR use at 75%. Can. Med. Assoc. J. 187(1):E17–E18, 2015.

    Article  Google Scholar 

  9. Ford, E. W., Menachemi, N., and Phillips, M. T., Predicting the adoption of electronic health records by physicians: When will health care be paperless? J. Am. Med. Inform. Assoc. 13(1):106–112, 2006.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hackos, J. T., and Redish, J., User and Task Analysis For Interface Design. New York: Wiley, 1998.

    Google Scholar 

  11. Hong Kong Legislative Council Panel on Health Services, Administration's paper on development of a territory-wide electronic healthcare record sharing system. LC Paper No. CB(2) 1006/08–09(03), 1–43, (2009).

  12. Iakovidis, I., Towards personal health record: Current situation, obstacles and trends in implementation of electronic healthcare record in Europe. Int. J. Med. Inform. 52(1):105–115, 1998.

    Article  PubMed  CAS  Google Scholar 

  13. Institute of Medicine, Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001.

    Google Scholar 

  14. Kandogan, E., and Shneiderman, B., Elastic Windows: a hierarchical multi-window World-Wide Web browser The Craft of Information Visualization (pp. 211–219): Elsevier, (2003).

  15. Karsh, B., Beyond usability: Designing effective technology implementation systems to promote patient safety. BMJ Qual. Saf. 13(5):388–394, 2004.

    Article  Google Scholar 

  16. Karsh, B., Holden, R. J., and Or, C. K. L., Human factors and ergonomics of health information technology implementation. In: Carayon, P. (Ed.), Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. 2nd edition. Boca Raton, FL: CRC Press, 2011, 249–264.

    Google Scholar 

  17. Keshavjee, K., Manji, A., Singh, B., and Pairaudeau, N., Failure of electronic medical records in Canada: A failure of policy or a failure of technology. Stud. Health. Technol. Inform. 143:107–114, 2009.

  18. Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., and Martinez, A., Barriers to electronic health record adoption: A systematic literature review. J. Med. Syst. 40(12):252, 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lambrew, J., More than half of doctors now use electronic health records thanks to administration policies. The White House Blog, 2013.

  20. Larkin, K., and Kelliher, A., Designing flexible EMR systems for recording and summarizing doctor-patient interactions (p. 1609–1614). Paper presented at the CHI'11 Extended Abstracts on Human Factors in Computing Systems, 2011.

  21. Larson, K., and Czerwinski, M., Web page design: Implications of memory, structure and scent for information retrieval (p. 25–32). Paper presented at the 1998 SIGCHI conference on Human Factors in Computing Systems, Los Angeles, 1998.

  22. Lei, J., Sockolow, P., Guan, P., Meng, Q., and Zhang, J., A comparison of electronic health records at two major Peking University Hospitals in China to United States meaningful use objectives. BMC Med. Inform. Decis. Mak. 13(1):96, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lorenzi, N. M., Kouroubali, A., Detmer, D. E., and Bloomrosen, M., How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Med. Inform. Decis. Mak. 9(15):1–13, 2009. https://doi.org/10.1186/1472-6947-9-15.

    Article  Google Scholar 

  24. Ludwick, D. A., and Doucette, J., Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. Int. J. Med. Inform. 78(1):22–31, 2009.

    Article  PubMed  CAS  Google Scholar 

  25. Miller, R. H., and Sim, I., Physicians’ use of electronic medical records: Barriers and solutions. Health Aff. 23(2):116–126, 2004.

    Article  Google Scholar 

  26. Ministry of Health, B. C., Canada,. Information Resource Management Plan 2007/08 ( https://www.health.gov.bc.ca/library/publications/annualrpts/irmp/IRMP_07_08_web.pdf ), (2005)

  27. Montague, E., and Lee, J. D., Trust in health technologies. In: Carayon, P. (Ed.), Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. 2nd edition. Boca Raton, FL: CRC Press, 2011, 281–291.

    Google Scholar 

  28. Nielsen, J., Usability Engineering. Boston: Academic Press, 1993.

    Google Scholar 

  29. Nielsen, J., Heuristic evaluation. In: Nielsen, J., Mack, R. L. (Eds), Usability Inspection Methods. New York: Wiley, 1994, 25–62.

    Google Scholar 

  30. Or, C., Pre-implementation case studies evaluating workflow and informatics challenges in private primary care clinics for electronic medical record implementation. Int. J. Healthc. Inf. Syst. Inform. 10(4):56–64, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Or, C., and Tao, D., Usability study of a computer-based self-management system for older adults with chronic diseases. JMIR Res. Protoc. 1(2):e13, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pacific Century Ventures, L., Electronic health records in China provide opportunities for international healthcare ventures. http://paccentury.com/electronic-health-records-in-china/ , 2016

  33. Saleem, J. J., Russ, A. L., Justice, C. F., Hagg, H., Ebright, P. R., Woodbridge, P. A., and Doebbeling, B. N., Exploring the persistence of paper with the electronic health record. Int. J. Med. Inform. 78(9):618–628, 2009.

    Article  PubMed  Google Scholar 

  34. Samuel, C. A., Area-level factors associated with electronic health record adoption and meaningful use in the Regional Extension Center Program. J. Am. Med. Inform. Assoc. 21(6):976–983, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shneiderman, B., The eyes have it: A task by data type taxonomy for information visualizations. Paper presented at the IEEE Conference on Visual Languages (p. 336–343), Los Alamitos, CA, USA, 1996

  36. Shneiderman, B., and Plaisant, C., Designing the user interface: strategies for effective human-computer interaction. 4th edition. Boston, MA: Addison-Wesley, 2004.

    Google Scholar 

  37. Simon, S. R., Kaushal, R., Cleary, P. D., Jenter, C. A., Volk, L. A., Poon, E. G. et al., Correlates of electronic health record adoption in office practices: A statewide survey. J. Am. Med. Inform. Assoc. 14(1):110–117, 2007.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sittig, D. F., and Singh, H., Eight rights of safe electronic health record use. J. Am. Med. Assoc. 302(10):1111–1113, 2009.

    Article  CAS  Google Scholar 

  39. Song, J., Trust in health infomediaries. Decis. Support. Syst. 43(2):390–407, 2007.

    Article  Google Scholar 

  40. Steinbrook, R., Health care and the American recovery and reinvestment act. N. Engl. J. Med. 360(11):1057–1060, 2009.

    Article  PubMed  CAS  Google Scholar 

  41. The Office of the National Coordinator for Health Information Technology, Quick Stats. http://dashboard.healthit.gov/quickstats/quickstats.php . Accessed May 2, 2018, 2016 .

  42. Thomas, D. R., A general inductive approach for analyzing qualitative evaluation data. Am. J. Eval. 27(2):237–246, 2006.

    Article  Google Scholar 

  43. Whitenton, K., Flat vs. deep website hierarchies. https://www.nngroup.com/articles/flat-vs-deep-hierarchy/ . Accessed May 2, 2018, 2013.

  44. Yeager, V. A., Walker, D., Cole, E., Mora, A. M., and Diana, M. L., Factors related to health information exchange participation and use. J. Med. Syst. 38(8):9, 2014. https://doi.org/10.1007/s10916-014-0078-1.

    Article  Google Scholar 

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Acknowledgements

This study was supported in part by the Hospital Authority of Hong Kong (contract research project RCGASNA100001C; PI: Calvin Or) and the University of Hong Kong. The authors thank Irene Cheung, Katie Wong, RN, and Antonio Sek, MD, for their assistance with data collection and experimental design.

Funding

This study was supported in part by the Hospital Authority of Hong Kong (contract research project RCGASNA100001C; PI: Calvin Or) and the University of Hong Kong.

Author information

Authors and Affiliations

  1. Department of Industrial & Manufacturing Systems Engineering, The University of Hong Kong, Pokfulam, Hong Kong

    Calvin Or

  2. Health Informatics Department, Hong Kong Hospital Authority, Kowloon, Hong Kong

    Ellen Tong & Summer Chan

  3. DeGroote School of Business, McMaster University, Hamilton, ON, Canada

    Joseph Tan

Authors
  1. Calvin Or
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  2. Ellen Tong
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  3. Joseph Tan
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  4. Summer Chan
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Contributions

CO, ET, and SC contributed to the study’s conception and design and supervised the study. CO and two researchers (IC and KW, mentioned in the acknowledgements) collected and analyzed the data. CO drafted the manuscript, and all of the authors critically discussed and revised the manuscript for intellectual content. All of the authors approved the final manuscript.

Corresponding author

Correspondence to Calvin Or.

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Conflict of interest

None declared.

Ethics approval and consent to participate

The research team received institutional review board approval from the University of Hong Kong (reference no: EA441010) and obtained the written informed consent of the participants prior to data collection.

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Not applicable.

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This article is part of the Topical Collection on Patient Facing Systems

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Or, C., Tong, E., Tan, J. et al. Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics. J Med Syst 42, 121 (2018). https://doi.org/10.1007/s10916-018-0971-0

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