External validation of the unified model of information systems continuance (UMISC): An international comparison.

CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.

Evaluation of the unified model of information systems continuance (UMISC) in two hospital environments.

CONTEXT: The deployment and long-term acceptance of clinical information systems (CISs) are faced with multiple difficulties. They include insufficient quality of the systems in place and resistance to the multiple changes they induce in care processes. Permanent evaluation of deployed solutions is a prerequisite to their continuous improvement. OBJECTIVE: The purpose of this study was twofold: (1) To validate the post-adoption unified model of information systems continuance (UMISC) progressively developed at the Georges Pompidou University Hospital (HEGP) in Paris (internal validation); and (2) To compare, using the same evaluation model, the results observed at HEGP with those of the Saint-Joseph Hospital Group (HPSJ), another Paris acute care institution (external validation). METHODS: The UMISC post-adoption model is built around nine dimensions: end-user characteristics, social norm (SN), IS quality (ISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), profession-adjusted use (PAU), satisfaction (SAT), and continuance intention (CI). Two semi-quantitative evaluation surveys were performed at HEGP in 2014 and 2015, and one at HPSJ in 2015. Statistical analysis included multiple regression analysis and structural equation modeling (SEM). RESULTS: The analysis concerned 459 responders, 264 at HEGP and 195 at HPSJ. UMISC indicators, with the exception of SN, are superior at HEGP than at HPSJ, which had a shorter CIS anteriority than HEGP. In SEM analysis, the UMISC model explained 25% and 40% of the CIS use, 92% and 93% of health professionals' satisfaction, and 72% and 71% of continuance intention at HEGP and HPSJ, respectively. Seventeen of the 21 tested UMISC hypotheses were supported in at least one of the two sites. CONCLUSION: The UMISC evaluation model can be used as a comparison and explanatory model of CIS use, satisfaction and continuance intention in post-CIS adoption situations that become prevalent in current electronic hospitals.