Perception and Adoption of an Electronic Medication Record Three Years after Deployment

Region Zealand’s electronic medication record is generally perceived by hospital staff as useful but not that easy to use. Neither perceived usefulness nor perceived ease of use is more than weakly correlated with actual adoption. The complex work domain with interdependent staff groups and many interrelated systems may be part of the explanation for the weak correlation. INTRODUCTION As part of the extensive efforts to substitute electronic patient records for paper records at Danish hospitals, an electronic medication record (EMR) system has been deployed at the hospitals in Region Zealand (one of five healthcare regions in Denmark). The system has been in operation for two to four years at the region’s hospitals, and work procedures involving the system have thus had time to stabilize. According to technology-acceptance research [1, 3] people’s adoption of a system depends to a considerable extent on their perception of its usefulness and ease of use, even when adoption is mandated. Several work procedures involving the EMR system are mandated in the region’s standard operating procedures for medication. This study aims to investigate (a) how the EMR system is perceived by the hospital staff after they have gained considerable experience with it and (b) how aspects of perceived usefulness and perceived ease of use correlate with adoption in a complex work domain. THE ELECTRONIC MEDICATION RECORD The EMR system is intended to help ensure that the right medication is given to the right patients at the right time. The system is used by both physicians and nurses for maintaining an overview of patients’ medication and specifically by physicians for ordering medication and by nurses for dispensing and administrating medication. Patients’ diagnoses, lab tests, treatments, and other nonmedication information are not documented in the EMR system but in other electronic and paper records. SURVEY METHODOLOGY This study consists of an online survey. An email requesting participation was sent to all function managers, department managers, ward managers, and EMR coordinators at the hospitals in Region Zealand, a total of 430 people. Participation in the survey was anonymous and after issuing two reminders we received 232 responses, for a response rate of 54%. The survey contained questions about the extent to which different parts of the system were used and the extent to which different work procedures involving the system were followed. The response categories for these questions were Always, Very often, Often, Rarely, Very Rarely, Never, and Don’t know. Participants were also asked to indicate their agreement to a number of statements about the usefulness and ease of use of the system. The response categories for these questions were Agree completely, Agree somewhat, Either, Disagree somewhat, and Disagree completely. Apart from these fixed-response questions participants were asked to describe barriers to using the system and following work procedures. In total the survey comprised 59 questions. RESULTS AND DISCUSSION Regarding perceived usefulness Table 1 shows that 64-73% of respondents agree (completely or somewhat) that the EMR system provides a good overview of the different parts of the medication process. The three remaining items about perceived usefulness concern the quality of the medication process and yield slightly less positive results. The median response for the item concerning whether the right medication is ordered is neutral, that is neither agreement nor disagreement. Several respondents comment that the EMR system has not reduced the number of medication errors but merely changed the types of medication error. Regarding perceived ease of use the results are more mixed. Medication ordering, which is the physicians’ responsibility, is perceived as simple by only 37% of respondents and as too time consuming by 61% of respondents. Conversely, dispensing and administration of medication, which is the nurses’ responsibility, is perceived as simple by 51% of respondents and as too time consuming by 39-40% of respondents. By comparing the ratings given by nurses (N = 129) and physicians (N = 94) we find that for two of the items about perceived usefulness and four of the items about perceived ease of use nurses and physicians assess the EMR system differently (Mann-Whitney tests, all ps < 0.05). Six of the 12 items in Table 1 correlate significantly with the extent to which system facilities are used and five items correlate significantly with the extent to which work procedures are followed. The correlations are however weak, suggesting either that adoption of the system does not yield sufficient benefit to produce consistently positive