Examining the Adoption and Implementation of Behavioral Electronic Health Records by Healthcare Professionals Based on the Clinical Adoption Framework (Preprint)
Authors: Yoo Sooyoung , Lim Kahyun , Jung Se Young , Lee Keehyuck , Lee Donghyun , Kim Seok , Lee Ho-Young , Hwang Hee 
Published: October 2020

BACKGROUND

The US Health Information Technology for Economic and Clinical Health Act of 2009, which was intended to stimulate the use of electronic health record (EHR) systems, has been amended to cover the behavioral health sector. Consequently, there is an increased need for research on the adoption of behavioral EHR systems by healthcare professionals. Various quantitative studies based on the unified theory of acceptance and use of technology model and technology acceptance model have been conducted in the general medical sectors, but few studies have been conducted in the behavioral sector and they have all been interview-based qualitative studies.

OBJECTIVE

To evaluate the adoption and implementation of a behavioral EHR system for behavioral clinical professionals through a modified clinical adoption (CA) research model quantitative study.

METHODS

We modified the existing CA framework to be suitable for evaluating the adoption of the EHR system by behavioral clinical professionals. The existing CA framework did not present questionnaire items. Accordingly, we designed a questionnaire with items that fit into the dimensions of the CA framework and it was verified through the review of behavioral clinical professionals and a pre-survey. The full-scale survey was administered in 5 US behavioral hospitals. The data were analyzed using a structural equation analysis. Additionally, open-ended question responses were qualitatively analyzed.

RESULTS

We derived a total of 7 dimensions, excluding dimensions that were evaluated as inappropriate for behavioral clinical professionals to respond. In addition, for 2 dimensions, 2 sub-dimensions were classified. A total of 409 behavioral clinical experts from 5 hospitals were surveyed. The ease of use and organizational support significantly influenced the use of the behavioral EHR system. Although the results were not significant, information quality (path coefficient=1.19, P>.05) and service quality (path coefficient=.085, P>.05) tended to influence the ease of use of the system. And Ease of Use (path coefficient=.253, P<.05) and the Organization (path coefficient=.802, P<.05) influenced the use of the system. The qualitative results indicated that the greatest advantage of the adoption of the behavioral EHR system was the ability to search for information quickly, work efficiently, and access patient information even outside of the hospital through the mobile app, resulting in having more time with patients. Conversely, the greatest disadvantage was an overdependence on the EHR system. Many staff members voiced concerns that their work could be paralyzed when the system was unstable.

CONCLUSIONS

This study designed a model for evaluating behavioral EHR adoption and conducted a quantitative study to derive the factors associated with the successful introduction of an EHR system in a behavioral environment.

CLINICALTRIAL

The study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (SNUBH) (IRB No.: B-1904-534-301).