University of Twente Student Theses


What makes doctors use the electronic patient record

Michel-Verkerke, Margreet B. (2003) What makes doctors use the electronic patient record.

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Abstract:This master thesis reports the results of the graduation assignment of the Master of Science study Business Information Technology of the University of Twente in Enschede. The objective of the assignment is to discover the reasons why some medical specialists use an Electronic Patient Record (EPR) in order to reveal why others do not. The research aims to answer the question: What product characteristics of an Electronic Patient Record and what user characteristics determine the successful use by physicians? The research starts with a literature study on the success of Information Systems, the medical specialist, the EPR and research methodology. The literature study leads to the construction of a conceptual model on the relation between user characteristics, product characteristics and the successful implementation of an EPR. Another result of the research is the construction of a questionnaire on user satisfaction with the EPR and the adjustment of the USE IT-interview-protocol. Both instruments are used to perform a case study to test the conceptual model. From the literature study can be learned that user satisfaction plays a central role in the success of Information Systems. User satisfaction depends on the four determinants of the USE IT-model: relevance, requirements, resistance and resources. Relevance is influenced by perceived usefulness, relative advantage, net benefits and compatibility. Ease of use, information quality and system quality set the requirements. Resistance is enhanced by complexity and reduced by trialability and observability. System quality and service quality are elements of the available resources. The medical specialist can be characterized as a medical professional, who performs a complex, non-routine job and who values his professional autonomy. The medical process, performed by medical specialists is an information-intensive process with high uncertainty and probability. It is also the central process in the whole care process and enables the start of other processes, like laboratory investigations and paramedical treatment. The patient record is used in every phase of the medical process. The main problems a medical specialist faces are shortage of time, staff and money, and inadequate patient data, resulting in the incapability to provide the desired quality of care. The main purpose of the patient record is to support the medical process. The paper record is familiar to physicians, but has some disadvantages. The most important problem is that it consists of a single hardcopy, that can only be in one place at the time and which can get lost. The Electronic Patient Record - on the other hand - can be shared by several users, but can also contain other functions like order entry, a decision support system and clinician reminders. The main disadvantages of an EPR are the needed investment in time and money, the changes in the working process and the possible resistance of physicians to data entry. Based on the literature study a conceptual model is constructed, which describes the requirements of physicians for the EPR. The case study consisted of USE IT-interviews with three medical specialists, who use an EPR, to reveal their user characteristics and a questionnaire to investigate the satisfaction with an EPR, which is filled out by nine medical specialists. The case study resulted in the adjustment of the conceptual model. From the research it can be concluded that a physician’s first objective is to provide a high quality of care to his patients. Relevance proved to be the major criterion for the adoption and success of the Electronic Patient Record. Resistance to innovations or the use of information systems hardly exists, but infringement of the professional autonomy can cause resistance. To the medical specialist relevance means the accessibility of all relevant patient data anywhere anytime within the hospital. The time saved on writing letters is the ‘tangible’ reward for making this decision. To make the EPR-implementation a success for physicians three requirements have to be met: 1. The EPR must contain all relevant data and functions, on all working locations and 24 hours a day. 2. Using the EPR must be compatible with the medical process of each individual specialist. 3. The EPR must allow different levels of authorization to protect the professional autonomy. Other requirements that influence the success of the implementation are: communication support, customization, minimal time required for training and adequate user support. The access to medical knowledge and tangible benefits like saving time from composing letters are very much appreciated, but are not decisive elements for the success. Active elements like decision-support and clinician reminders are not missed. In contrast with what was expected from literature, ease of use and especially data entry proved not to be a major problem. But the interrogated specialists expect that data entry could slow down the further implementation among fellow specialists.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Business Information Technology MSc (60025)
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