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FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 11FÖV/SPEA Workshop 2011Robert Piehler & Linda MorySpeyer, July 16th 2...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 21. Introduction2. Basic Terminological Principles3. Research Question...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 3• The U.S. as well as the German health care system face challengeson...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 4A representative study from 2009:On the basis of responses from63.1% ...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 52. Basic Terminological Principles3. Research Question4. Methodologic...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 6ISO Definiton of eHRAlthough there is no universally accepted definit...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 7eHR can be classified as:• Comprehensive eHRSystems• Basic eHR System...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 83. Research Question4. Methodological ApproachOutline5. Conclusion1. ...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 93. Research Question• Which factors determine the acceptance of eHR f...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 10Barriers:• Inadequate IT Staff• Physicians Resistance• …Facilitators...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 11Outline5. Conclusion1. Introduction2. Basic Terminological Principle...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 121. vgl. Venkatesh et al (2003).2. vgl. Fishbein/Ajzen (1975).3. vgl....
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 131. vgl. Davis et al. (1989).2. vgl. Bruner/James/Hensel (2001); Davi...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 14Solution:• Identification of indicators which can be measuredexplici...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 15Outline5. Conclusion1. Introduction2. Basic Terminological Principle...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 165. Conclusion• Given the increasing importance of eHealth, this rese...
FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 17Thank You
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The Acceptance of Electronic Health Records among Hospitals - An Intercultural Comparison between the USA and Germany

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  1. 1. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 11FÖV/SPEA Workshop 2011Robert Piehler & Linda MorySpeyer, July 16th 2011The Acceptance of Electronic HealthRecords among HospitalsAn Intercultural Comparison between the USA andGermany
  2. 2. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 21. Introduction2. Basic Terminological Principles3. Research Question4. Methodological ApproachOutline5. Conclusion
  3. 3. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 3• The U.S. as well as the German health care system face challengeson 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 healthcare provider2 and to improve the quality of care while controlling healthcare costs3• Despite broad consensus on the potential benefits of electronic healthrecords and other forms of health information technology, U.S. and Germanhealth care providers have been slow to adopt them• Therefore, the question arises, what factors positively influence theacceptance of the eHR in the United States and Germany• Are there major differences between those two countries and if so, whatcould be reasons for thatCurrent Situation in the United States and Germany I1. Introduction1. 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)
  4. 4. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 4A representative study from 2009:On the basis of responses from63.1% of hospitals surveyed, only1.5% of U.S. hospitals have acomprehensive electronic-records system (i.e., present inall clinical units), and anadditional 7.6% have a basicsystem (i.e., present in at leastone clinical unit). Computerizedprovider-order entry formedications has beenimplemented in only 17% ofhospitals.United States GermanyNo studies found:Because electronic health recordin Germany is integrated in theelectronic health card.1. IntroductionCurrent Situation in the United States and Germany II
  5. 5. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 52. Basic Terminological Principles3. Research Question4. Methodological ApproachOutline5. Conclusion1. Introduction
  6. 6. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 6ISO Definiton of eHRAlthough there is no universally accepted definition of eHR, consensus is emerging thatelectronic documentation of providers’ notes, electronic viewing of laboratory and radiologyresults, and electronic prescribing (known as computerized provider order entry, or CPOE) arekey components of an eHR – these are some of the elements identified by the Institute ofMedicine (IOM) in a report on the features of eHR systemsSynonyms that are often used in the context of eHR: electronic patient record (ePR), electronicmedial record (eMR) or computerised patient recordBasic-generic eHR DefinitionEHR is a repository of information regarding the healthstatus of a subject of care, in computer processableform.This definition (to be called the “basic-generic eHR”) isintentionally concise and generic to ensure the broadestapplicability to the widest range of existing and futureusers of eHRs and eHR systems.Integrated Care eHR DefinitionThe Integrated Care eHR (ICeHR) is defined as a repositoryof information regarding the health status of a subject of carein computer processable form, stored and transmittedsecurely, and accessible by multiple authorised users. It hasa standardised or commonly agreed logical informationmodel which is independent of EHR systems. Its primarypurpose is the support of continuing, efficient and qualityintegrated health care and it contains information which isretrospective, concurrent, and prospective.2. Basic Terminological PrinciplesDefinition eHR
  7. 7. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 7eHR can be classified as:• Comprehensive eHRSystems• Basic eHR Systems withClinical Notes• Basic eHR Systemswithout Clinical Notes2. Basic Terminological PrincipleseHR Classification in the United States
  8. 8. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 83. Research Question4. Methodological ApproachOutline5. Conclusion1. Introduction2. Basic Terminological Principles
  9. 9. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 93. Research Question• Which factors determine the acceptance of eHR from a healthcareprovider perspective?• How do these factors influence acceptance and use of eHR?• Which external effects moderate the relation between factors andacceptance?• Which differences exist between healthcare providers from distinctcountries/national healthcare systems?Main Research Questions
  10. 10. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 10Barriers:• Inadequate IT Staff• Physicians Resistance• …Facilitators:• Technical Support• Financial Incentives• …1. vgl. Ashish et al (2009)Possible Barriers and Facilitators3. Research Question
  11. 11. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 11Outline5. Conclusion1. Introduction2. Basic Terminological Principles4. Methodological Approach3. Research Question
  12. 12. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 121. vgl. Venkatesh et al (2003).2. vgl. Fishbein/Ajzen (1975).3. vgl. Davis (1986).4. vgl. Davis/Bagozzi/Warshaw (1989).4. Methodological ApproachPerformanceExpectancyEffort ExpectancyBehavioralIntentionUseBehaviourSocial InfluenceFacilitatingConditionsVoluntarinessof UseExperienceAgeGenderUnified Theory of Acceptance (UTAUT) I• Individual Level• Rational Approach• IT-Focus• Self-Assessment/Self-Evaluation
  13. 13. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 131. vgl. Davis et al. (1989).2. vgl. Bruner/James/Hensel (2001); Davis/Bagozzi/Warshaw (1989).3. Venkatesh et al. (2003)PerformanceExpectancyEffort Expectancy Social InfluenceFacilitatingConditionsBehavioralIntentionUseBehaviourFacilitatingconditions aredefined as thedegree to which anindividual believesthat anorganizationaland technicalinfrastructure existsto support use ofthe system. 3Social influence isdefined as thedegree to which anindividual perceivesthat importantothersbelieve he or sheshould use the newsystem.3Effort expectancy isdefined as thedegree of easeassociated with theuse of the system.1Performanceexpectancy isdefined as thedegree to which anindividual believesthat using thesystem will helphim or her to attaingains in jobperformance.1BehavioralIntention is definedas the tendency tobehave in a certainway.2Use Behaviour isdefined as actualusage of the ITsystem.4. Methodological ApproachPerformanceExpectancyEffort ExpectancyBehavioralIntentionUseBehaviourSocial InfluenceFacilitatingConditionsVoluntarinessof UseExperienceAgeGenderUnified Theory of Acceptance (UTAUT) II
  14. 14. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 14Solution:• Identification of indicators which can be measuredexplicitly to measure the latent variables indirectly• Calculation of the correlations between theindicators• Decomposition of the indicator correlations to thecorrelations of the latent variables• Calculation of the correlations between the latentvariables by solving a multidimensional linearsystem of equationsEmpirical validation of latent construct, which was deduced from theory, and its relations toother constructs.Point of Departure Examples Problem• A system of relations whichhas been deduced from theoryneeds to be tested byempirical analysis• The acceptance of eHR isdetermined by reduced costs ofaction.• The interaction configurationbetween the stakeholders isrelevant for the acceptance ofeHC.• Regression analysis can beemployed for the 1stexample since all variablescan be measured directly.However, in the 2ndexample the variablescannot be measured directly.They are latent.4. Methodological Approach1x1x21y1y2Measurement modelof the latent exogenousvariablesStructural model2y3y4Measurement modelof the latent endogenousvariables12Methodology: Structural Equation Modelling
  15. 15. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 15Outline5. Conclusion1. Introduction2. Basic Terminological Principles3. Research Question4. Methodological Approach
  16. 16. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 165. Conclusion• Given the increasing importance of eHealth, this research sketchconcentrates on the issue of acceptance regarding the use of electronichealth records• Based on both the UTAUT model (Venkatesh et al. 2003) and the relevantliterature, important factors influencing the attitude towards and thepotential use of the eHR are presented in order to conceptualize andintegrate them in a research model later• The goal is to conduct a comparative empirical examination throughoutthe United States and Germany analysing the data with structuralequation modeling using AMOS statistics softwareConclusion
  17. 17. FÖV/SPEA Workshop 2011: Robert Piehler & Linda Mory 17Thank You
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