Electronic medical records and computerized physician order entry: Examining factors and methods that foster clinician IT acceptance in pediatric hospitals

Abstract

Electronic medical records (EMR) and computerized provider order entry (CPOE) are recognized as a means to improve quality of care and patient safety. This research examines factors that contribute to clinician acceptance of an EMR implemented in a pediatric hospital system and applies this knowledge to improve implementation methods to ensure they foster acceptance. A framework for User-Centered Implementation (UCI) was developed based on previous EMR and CPOE, technology acceptance, user-centered design, and change management research. The UCI framework identifies tools from change management and user-centered design and links them to the systems development lifecycle stage(s) at which they can be applied to achieve improved user acceptance. Next, a study examined clinician EMR acceptance in a pediatric hospital system at various points during their EMR implementation which employed a UCI-based methodology. Surveys before and after implementation of each phase examined physician, nurse, and other staff perceptions about the systems usefulness (performance expectancy (PE)) and ease of use (effort expectancy (EE)). Results indicate users had positive perceptions of system ease of use (EE) after implementation. Post-implementation PE ratings were neutral or positive for most users. Pre- and post-implementation regression models indicate the factors that influence PE change over time. Compatibility with clinician work practices was important both before and after implementation. Before implementation, users who perceived a greater need for the system and felt their needs were represented during design had higher expectations of system usefulness. After implementation, system characteristics including how well it supports clinical decision making and how easy it is to use influenced PE. Support provided by super users positively influenced both PE and EE after implementation. Based on these findings, guidelines for using UCI to improve clinician acceptance of EMR are presented. Designing EMR systems that are usable within the clinical work context enables clinicians to focus on the patient, rather than the system. Accomplishing this in practice is difficult given the complexity of EMRs and the dynamic clinical processes they support. This studys results indicate the UCI framework can be effectively applied to EMR implementations to improve the usability, utility, and, consequently, acceptance of these systems.