The Acceptance of Electronic Health Records among Hospitals - An Intercultural Comparison between the USA and Germany

FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 1

1

FÖV/SPEA Workshop 2011

Robert Piehler & Linda Mory

Speyer, July 16th 2011

The Acceptance of Electronic Health

Records among Hospitals

An Intercultural Comparison between the USA and

Germany


1. Introduction

2. Basic Terminological Principles

3. Research Question

4. Methodological Approach

Outline

5. Conclusion


• The U.S. as well as the German health care system face challenges

on multiple fronts, including rising costs and inconsistent quality1

• Health information technology, especially electronic health records (eHR),

has the potential to improve the efficiency and effectiveness of health

care provider2 and to improve the quality of care while controlling health

care costs3

• Despite broad consensus on the potential benefits of electronic health

records and other forms of health information technology, U.S. and German

health care providers have been slow to adopt them

• Therefore, the question arises, what factors positively influence the

acceptance of the eHR in the United States and Germany

• Are there major differences between those two countries and if so, what

could be reasons for that

Current Situation in the United States and Germany I

1. Introduction

1. Smith et al. (2004); Jha et al. (2005); Pfaff/Ernstmann (2007); Ashish et al. (2009)

2. Ashish et al. (2009); Chaudhry et al. (2006); Blumenthal/Glaser (2007)

3. Ashish et al. (2006)


A representative study from 2009:

On the basis of responses from

63.1% of hospitals surveyed, only

1.5% of U.S. hospitals have a

comprehensive electronic-

records system (i.e., present in

all clinical units), and an

additional 7.6% have a basic

system (i.e., present in at least

one clinical unit). Computerized

provider-order entry for

medications has been

implemented in only 17% of

hospitals.

United States Germany

No studies found:

Because electronic health record

in Germany is integrated in the

electronic health card.

1. Introduction

Current Situation in the United States and Germany II





Outline

5. Conclusion

1. Introduction


ISO Definiton of eHR

Although there is no universally accepted definition of eHR, consensus is emerging that

electronic documentation of providers’ notes, electronic viewing of laboratory and radiology

results, and electronic prescribing (known as computerized provider order entry, or CPOE) are

key components of an eHR – these are some of the elements identified by the Institute of

Medicine (IOM) in a report on the features of eHR systems

Synonyms that are often used in the context of eHR: electronic patient record (ePR), electronic

medial record (eMR) or computerised patient record

Basic-generic eHR Definition

EHR is a repository of information regarding the health

status of a subject of care, in computer processable

form.

This definition (to be called the “basic-generic eHR”) is

intentionally concise and generic to ensure the broadest

applicability to the widest range of existing and future

users of eHRs and eHR systems.

Integrated Care eHR Definition

The Integrated Care eHR (ICeHR) is defined as a repository

of information regarding the health status of a subject of care

in computer processable form, stored and transmitted

securely, and accessible by multiple authorised users. It has

a standardised or commonly agreed logical information

model which is independent of EHR systems. Its primary

purpose is the support of continuing, efficient and quality

integrated health care and it contains information which is

retrospective, concurrent, and prospective.


Definition eHR


eHR can be classified as:

• Comprehensive eHR

Systems

• Basic eHR Systems with

Clinical Notes

• Basic eHR Systems

without Clinical Notes


eHR Classification in the United States




Outline

5. Conclusion

1. Introduction




• Which factors determine the acceptance of eHR from a healthcare

provider perspective?

• How do these factors influence acceptance and use of eHR?

• Which external effects moderate the relation between factors and

acceptance?

• Which differences exist between healthcare providers from distinct

countries/national healthcare systems?

Main Research Questions


Barriers:

• Inadequate IT Staff

• Physicians Resistance

• …

Facilitators:

• Technical Support

• Financial Incentives

• …

1. vgl. Ashish et al (2009)

Possible Barriers and Facilitators



Outline

5. Conclusion

1. Introduction





1. vgl. Venkatesh et al (2003).

2. vgl. Fishbein/Ajzen (1975).

3. vgl. Davis (1986).

4. vgl. Davis/Bagozzi/Warshaw (1989).


Performance

Expectancy

Effort ExpectancyBehavioral

Intention

Use

Behaviour

Social Influence

Facilitating

Conditions

Voluntariness

of UseExperienceAgeGender

Unified Theory of Acceptance (UTAUT) I

• Individual Level

• Rational Approach

• IT-Focus

• Self-Assessment/Self-Evaluation


1. vgl. Davis et al. (1989).

2. vgl. Bruner/James/Hensel (2001); Davis/Bagozzi/Warshaw (1989).

3. Venkatesh et al. (2003)

Performance

ExpectancyEffort Expectancy Social Influence

Facilitating

Conditions

Behavioral

Intention

Use

Behaviour

Facilitating

conditions are

defined as the

degree to which an

individual believes

that an

organizational

and technical

infrastructure exists

to support use of

the system. 3

Social influence is

defined as the

degree to which an

individual perceives

that important

others

believe he or she

should use the new

system.3

Effort expectancy is

defined as the

degree of ease

associated with the

use of the system.1

Performance

expectancy is

defined as the

degree to which an

individual believes

that using the

system will help

him or her to attain

gains in job

performance.1

Behavioral

Intention is defined

as the tendency to

behave in a certain

way.2

Use Behaviour is

defined as actual

usage of the IT

system.


Performance

Expectancy

Effort ExpectancyBehavioral

Intention

Use

Behaviour

Social Influence

Facilitating

Conditions

Voluntariness

of UseExperienceAgeGender

Unified Theory of Acceptance (UTAUT) II


Solution:

• Identification of indicators which can be measured

explicitly to measure the latent variables indirectly

• Calculation of the correlations between the

indicators

• Decomposition of the indicator correlations to the

correlations of the latent variables

• Calculation of the correlations between the latent

variables by solving a multidimensional linear

system of equations

Empirical validation of latent construct, which was deduced from theory, and its relations to

other constructs.

Point of Departure Examples Problem

• A system of relations which

has been deduced from theory

needs to be tested by

empirical analysis

• The acceptance of eHR is

determined by reduced costs of

action.

• The interaction configuration

between the stakeholders is

relevant for the acceptance of

eHC.

• Regression analysis can be

employed for the 1st

example since all variables

can be measured directly.

However, in the 2nd

example the variables

cannot be measured directly.

They are latent.


1

x1

x2

1

y1

y2

Measurement model

of the latent exogenous

variablesStructural model

2

y3

y4

Measurement model

of the latent endogenous

variables

1

2

Methodology: Structural Equation Modelling


Outline

5. Conclusion

1. Introduction





5. Conclusion

• Given the increasing importance of eHealth, this research sketch

concentrates on the issue of acceptance regarding the use of electronic

health records

• Based on both the UTAUT model (Venkatesh et al. 2003) and the relevant

literature, important factors influencing the attitude towards and the

potential use of the eHR are presented in order to conceptualize and

integrate them in a research model later

• The goal is to conduct a comparative empirical examination throughout

the United States and Germany analysing the data with structural

equation modeling using AMOS statistics software

Conclusion


Thank You

Health & Medicine

The Acceptance of Electronic Health Records among Hospitals - An Intercultural Comparison between the USA and Germany