Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation.

OBJECTIVE: To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. MATERIALS AND METHODS: A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. Analyses were performed with structural equation modelling techniques. RESULTS: A total of 389 answers from chronically ill and 383 from well participants were collected. Perceived usefulness was the key explanation of the intention to use PHRs for both ill and well people (total effect of 0.601 and 0.565, respectively) followed by security, privacy and trust in PHRs (total effect of 0.377 and 0.479, respectively). Conversely, computer anxiety was perceived as a significant barrier (total effect of -0.327 for ill individuals and -0.212 for well individuals). DISCUSSION: The model proposed was appropriate in explaining key consumer positive and negative perceptions on electronic PHR use. We found little difference in perceptions of electronic PHRs between chronically ill and well individuals, although self-reporting their health status might have influenced the results. CONCLUSIONS: To increase the adoption rate of electronic PHRs among both chronically ill and well consumers it is necessary to reinforce consumer perceptions of the usefulness of and trust in these eHealth technologies while mitigating their anxieties about computer use in general.

A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.

BACKGROUND: There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. OBJECTIVE: We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. METHODS: We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. RESULTS: We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers. CONCLUSIONS: Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.

Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach.

Pervasive healthcare support through mobile information technology solutions is playing an increasing role in the attempt to improve healthcare and reduce costs. Despite the apparent attractiveness, many mobile applications have failed or have not been implemented as predicted. Among factors possibly leading to such outcomes, technology adoption is a key problem. This must be investigated early in the development process because healthcare is a particularly sensitive area with vital social implications. Moreover, it is important to investigate technology acceptance using the support of scientific tools validated for relevant information systems research. This article presents an empirical study based on the Technology Acceptance Model 2 in mobile homecare nursing. The study elicited the perceptions of 91 Canadian nurses who used personal digital assistants for 1 month in their daily activities. A partial least squares modeling data analysis revealed that nurse's perception of usefulness is the main factor in the adoption of mobile technology, having subjective norm and image within the organization as significant antecedents. Overall, this study was the first attempt at investigating scientifically, through a pertinent information systems research model, user adoption of mobile systems by homecare nursing personnel.

Can wireless text messaging improve adherence to preventive activities? Results of a randomised controlled trial.

OBJECTIVE: To determine the effectiveness of cell phone wireless text messaging for improving adherence to a healthy behaviour. DESIGN: A randomised, unblinded, controlled trial was conducted with 102 subjects, 18 years or older, each having a cell phone and willing to take 1 vitamin C pill per day for 1 month for preventive reasons. Intervention group participants received text messaging reminders and were asked to acknowledge receiving their messages after taking the vitamins, whereas control group subjects had no text messaging activity. MEASUREMENTS: Self-reported adherence and the number of participant text messages acknowledging vitamins taken. RESULTS: Both groups reported an increased adherence after the trial: by 246% for the intervention group and by 131% for the control group. There was a non-significant difference between the two groups at endpoint: an average difference of 0.8 between the number of pills missed in the last week of the trial (2.5 out of 7 in the intervention and 3.3 out of 7 in the control group) with a power of 0.54. The study revealed a significant correlation (coefficient=-0.352, sig.=0.01) between the average number of text messaging acknowledgements sent by the intervention group participants and the number of pills they reported missed during the last week of the trial. CONCLUSION: This was a small randomised controlled trial with inconclusive but encouraging results. It suggests a new approach in addressing insufficient adherence in outpatient conditions and shows that the use of information technology tools for compliance warrants further research.

Would people pay for text messaging health reminders?

The aim of this study is to determine the time and financial limitations that people would accept for using a telehealth service consisting of wireless text messaging reminders to improve adherence to a recommended healthy regimen. An empirical study based on a 1-month trial of a prototype system that studied adherence to a specified healthy behaviour was conducted. Fifty-one participants received daily cell phone text messaging reminders on taking one vitamin C pill daily for preventive reasons. At the end of the trial they answered a survey regarding their willingness to pay for and to stay with such a service, if offered. If usage were free, only 45% of the participants would continue to use it for a long indefinite period of time. If the usage were for a fee, 29% of the participants would use the service just a few weeks; 28% would use it an indefinite period of time if they could see its usefulness and if the cost were reasonable. The median amount indicated by the participants as a reasonable monthly fee for such a service was $5. Although the study did not evaluate perceived usefulness to use the telehealth service explicitly, a benefit perception proved to condition participant willingness to use the service and to pay for it, if necessary. If people perceive usefulness, they want to use the service, even for a fee. A free service would not be used if it is not perceived as beneficial.

A framework for mobile healthcare answers to chronically ill outpatient non-adherence.

Non-adherence (also known as 'non-compliance') is a major barrier undermining healing efforts within out-of-hospital self-management programmes, resulting in waste of human and social resources. This study suggests a theoretical framework of activities through which mobile patient solutions might address non-adherence determinants in a broader context of clinical interventions. The goal of the paper is to explore a dilemma associated with such interventions: the uncertainty regarding the level of patient involvement and technology support. We follow a critical orientation approach in discussing this multi-faceted conundrum: we summarise the latest vision on adherence factors, we suggest several types of interventions through which mobile healthcare solutions could address them, and we explore in detail the dilemma of patient and technology roles. We conclude that there is no universally optimal solution, and practical conditions depending on patient, disease, treatment and healthcare system are determining factors in prescribing the level of patient involvement and technology support. Our work is intended to stimulate further research into the nature of mobile solutions in health care and, especially, into patient acceptance aspects, in an endeavour to contribute to improving adherence with minimum obtrusiveness.

M-healthcare for patient self-management: a case for diabetics.

Disease management facilitated through information technology could mean a step forward towards a more effective and efficient care of patients afflicted with chronic illnesses. Focusing on diabetes, the paper explores the value proposition of wireless technology in enhancing patient self-management and quality of life. Diabetics' non-compliance with prescribed treatment plans mandates the adoption of advanced tools that can support patients through automated functions (e.g., notification reminders for taking medication), decision-support (e.g., analysis of self-test data and feedback), and anytime/anywhere communication and intervention capability (e.g., emergency consultation by healthcare practitioner). A cost-benefit analysis for the mobile self-management of diabetics suggests time and financial savings for both patients and the healthcare providers.