This study evaluated the adoption of electronic medical record (EMR)-based information systems in three public hospitals in Korea that were introduced in July 2012. Surveys of doctors and nurses before and after implementation found increasing intention to use and perceived benefits around reduced medication errors over time. However, barriers like technical capabilities, lack of organizational support, and time requirements initially hindered adoption. The study aims to provide insights to improve EMR system quality and implementation processes based on Rogers' diffusion theory and DeLone and McLean's IS success model.

1. LITERATURE REVIEW
MI-227
Clinical & Laboratory Information Systems
Coursework 1

2. DIFFUSION OF ELECTRONIC MEDICAL RECORD BASED
PUBLIC HOSPITAL INFORMATION SYSTEMS
Kyoung Won Cho, PhD
Seong Min Kim, BS
Department of Healthcare Administration, Kosin University, Busan
Chang-Ho An, MPH
The Korea Association of Regional Public Hospital, Seoul
Young Moon Chae, PhD
Department of Health Informatics,
Graduate School of Public Health, Yonsei University, Seoul, Korea

3. INTRODUCTION

4. THE STUDY AT A GLANCE
➤ Aims to evaluate adoption behavior and processes
➤ Electronic Medical Record (EMR)-based information
system(IS)
➤ Three public hospitals in Korea, (Andong, Taegu, and
Pohang)
➤ Introduced on July 1, 2012
➤ Focus on doctors and nurses
➤ Evaluated through Rogers’ Diffusion Theory

5. FACTS:
➤ In Korea, over 90% of hospitals
are private.
➤ Facilities and manpower of most
public hospitals are less
competitive than those of private
hospitals.
➤ Previous studies showed lower
adoption rates of EMR for public
hospitals, as they play important
roles in providing medical and
preventive services to low-
income patients.
➤ In 2012, Korean government
began to disseminate a newly
developed EMR-based IS to
strengthen their service capacity.

6. STUDY METHODS
➤ The researchers modified Perfomance Reference Model (PRM),
classifying it as Input, Process, Business and Performance layers.
➤ For each layer, a set of Key Performance Indicators (KPI) was
developed to measure performance of a specific IS.
➤ Selected KPI’s were identified and used to evaluate IS project in a
public hospital setting based on the PRM framework.
➤ User satisfactions score from four performance layers were
analyzed before implementation and two times after to evaluate
the adoption process of the IS with Rogers’ diffusion theory.
➤ DeLone and McLean’s information system (IS) success model
was also utilized as a dependent variable.

7. SUBJECTS:
➤ Prior to using the system, 56
doctors and 359 nurses
participated in the study.
➤ After a month of experience
with the system the study
includes 50 doctors and 349
staff nurses.
➤ In addition, 53 doctors and
455 nurses were surveyed
after seven months of
experience.

8. KEY PERFORMANCE INDICATORS:
INPUT layer

9. KEY PERFORMANCE INDICATORS:
PROCESS layer

10. KEY PERFORMANCE INDICATORS:
BUSINESS layer
PERFORMANCE
layer

11. RESULTS
➤ Scores of ‘intention to use’
high among doctors.
➤ Scores for ‘reduced medication
errors’, increased in the third
survey for both doctors and
nurses.
➤ As with previous studies the
participants also considered
the effect of the new IS on the
clinical environment to be
positive.

12. RESULTS
➤ Several EMR adoption barriers
during initiation stage include:
1. Technical capabilities of
physicians to use an EMR
system.
2. Lack of support from
organization culture and
management
3. Time to enter data into the
EMR system.
4. Economic and knowledge
barriers (g., lack of
computer skills to use EMR)

13. RESULTS
➤ Implication to improve the
system:
1. System quality (response
time, system performance,
amount of input
requited.)
➤ Study limitations.
Different respondents for
each survey.
Insufficient system capacity
and slow response time.

14. REFERENCES:
➤ Cho, Kyoung Won, Seong Min Kim, Chang-Ho An, and Young
Moon Chae. “Diffusion of Electronic Medical Record Based
Public Hospital Information Systems.” Healthcare Informatics
Research 21, no. 3 (July 2015): 175–83. doi:10.4258/hir.
2015.21.3.175.
➤ Nils Urbach, Benjamin Müller. “The Updated DeLone and
McLean Model of Information Systems Success” 1 (2011): 1–
18. doi:10.1007/978-1-4419-6108-2_1.
➤ Rogers, Everett M. Diffusion of Innovations, 4th Edition.
Simon and Schuster, 2010.