Extending the Unified Theory of Acceptance and Use of Technology (UTAUT) to understand electronic healthcare record implementation : the role of perceived goal attainment, perceived velocity and team learning behaviour

With the strong on-going interest and effort to push investment in the implementation of Electronic healthcare record (EHR), understanding the factors that will drive the use of the system has important scientific and practical significance. However, there is sparse literature on understanding what influence healthcare professionals (i.e. doctors, paraprofessionals and administrative personnel)’s motivation to learn and use EHR. Against this backdrop, the key objective of this thesis is to examine the factors that influence healthcare professionals’ behavioural intention to adopt and actual use of electronic healthcare record in Malaysia. The research questions for this thesis are 1) Can Unified Theory of Acceptance and Use of Technology (UTAUT) factors predict healthcare professionals’ motivation to learn and the behavioural intention to adopt and accept EHR? 2) Can the extended model of UTAUT that includes goal attainment, perceived velocity and team learning behaviour better predict healthcare professionals’ motivation to learn and the behavioural intention to adopt and accept EHR? and 3) Is there a significant relationship between motivation to learn EHR and EHR behavioural intention to adoption and acceptance of EHR among Malaysian healthcare professionals? The key theoretical underpinning this research is based on UTAUT. UTAUT is extended in this research by integrating theories from goal pursuits (i.e. perceive goal attainment and perceived velocity) and team learning behaviour. Furthermore, the role of motivation to learn EHR in influencing behavioural intention and actual use of EHR was also studied. Working together with a Malaysian medical group that has more than 200 clinics, longitudinal data was collected from doctors, paraprofessionals and administrators in three waves over 6 months periods during pre-implementation of the EHR (T1), 2-3 months (T2) during implementation, and 4-5 months (T3) after sustained continuous implementation. Overall, 520 surveys were collecting during pre-implementation at T1, 210 during implementation in month 2-3 at T2, and 182 in sustained implementation in month 4-5 at T3. The data were analysed using PLS-SEM. The results showed that while UTAUT can partially explain healthcare professionals’ behavioural intention and actual use of EHR, while the extended model with new variables introduced in this thesis significantly explain the mechanisms leading to EHR adoption. Furthermore, the results show that the adoption factors vary in their relationships with behavioural intention and actual use of EHR at different implementation stages. This thesis contributes to previous EHR adoption studies as well as UTAUT literature by replicating UTAUT in this research to test if UTAUT’s can be replicated in an Asian context, as well as providing an improved UTAUT to study EHR adoption. Besides integrating UTAUT with theories related to goal pursuit, team learning behaviour and motivation to learn information systems, the new model was also tested with longitudinal data, which has an advantage over cross-sectional data, in that it is able to test the model from implementation stage to adoption. This thesis also informs practice by providing guidelines and strategies to healthcare companies that plan to implement EHR. Contrary to many previous practices employed by organizations, rather than having a one size fits all training programme, companies can highlight on the features (e.g. performance expectancy) or easiness to learn the system (e.g. effort expectancy) to different user groups. Clinics and hospitals that are implementing EHR should note that motivation to learning EHR will lead to better actual use of the system in the early stage of EHR implementation. Therefore healthcare professionals should be provided with the necessary facilities and training to motivate them to learn. Given that team learning behaviour influence users’ motivation to adopt EHR, companies can also consider forming small group, need-based trainings so that learning can be fun with strong group dynamics. These groupings can also be based on task or job functions so that users can learn from each other and keep motivation level high. Lastly, in the early stage of EHR implementation, companies should continue to ensure that employees are motivated to learn how to use EHR and to provide support when needed so that staff are encouraged and motivated to continue using the system.