Investigation of national readiness for e-Health in a South East European country: technology acceptance for electronic health records

Background
The successful implementation of information and communication technology (ICT) in healthcare presents many challenges; the failures outnumber the successes in the implementation of ICT in the health sector. A better understanding of technology acceptance among healthcare professionals will be useful for managers in overcoming barriers to adopting ICT in healthcare.

Aim and objectives
The principal gap in the literature that this research was intended to address was the lack of knowledge about the implementation and acceptance of e-Health and electronic health record (EHR) technologies among healthcare professionals in the Republic of Macedonia, in South East Europe (SEE). This research was intended to assess national readiness for acceptance of e-Health/EHR systems in an SEE country through technology acceptance, and to identify the main predictors of behavioural intentions towards e-Health/EHR. Using these findings, it was hoped to propose management, policy and government measures to increase healthcare professionals’ acceptance of e-Health/EHR systems. The ultimate aim of this is to improve the quality of services for patients and provide better health care.

Methods
A positivist quantitative approach was used for the research undertaken for this Thesis. A research instrument based on modified technology acceptance models was developed and six hypotheses were tested. Attitudes of healthcare professionals to the new e-Health/EHR systems were assessed through two studies. A new model presenting healthcare professionals’ attitudes to the e-Health/EHR systems was developed, and technology acceptance predictors were identified.

Results
Hierarchical linear regression, stepwise linear regression, and structural equation modelling indicated that perceived ease of use and effort expectancy are the strongest determinants of healthcare professionals’ attitudes concerning their intention to use future e-Health/EHR systems. Perceived usefulness and performance expectancy were excluded, or showed a weak effect in the overall prediction model. The findings on the importance of technology acceptance constructs (perceived ease of use and effort expectancy) are novel, and differ from those described in the relevant literature, where perceived usefulness and performance expectancy were identified as the most effective predictors of behaviour in healthcare settings. Technology acceptance variables such as job relevance, subjective norm, facilitating conditions, descriptive norm, and social influence were identified as having a strong influence on intentions to use prospective e-Health/EHR systems.

Conclusions
This research assessed the national readiness for acceptance of future e-Health/EHR systems in an SEE country, and yielded novel findings that contribute to our current knowledge of technology acceptance in healthcare. Therefore, the findings of this Thesis can serve as a basis on which to build a bridge between policy makers, (i.e., government and management), industry, (i.e., producers of ICT hardware and software for healthcare), and end users (i.e., healthcare professionals). A set of specific measures are proposed for future managerial and policy interventions concerning the implementation of e-Health/EHR systems in a developing country in SEE. Finally, this may have many benefits, including reducing time and costs, making the adoption of e-Health/EHR systems more efficient and providing more effective healthcare.