Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals

Abstract

BackgroundWith the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings.MethodsA quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects.ResultsThe findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P < 0.05) and user satisfaction (β = 0.53, P < 0.01); information quality has significant influence on EMR use (β = 0.44, P < 0.05) and user satisfaction (β = 0.48, P < 0.01) and service quality has strong significant influence on EMR use (β = 0.36, P < 0.05) and user satisfaction (β = 0.56, P < 0.01). User satisfaction has significant influence on EMR use (β = 0.41, P < 0.05) but the effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P < 0.01; β = 0.60, P < 0.01), respectively. Additionally, computer literacy was found to be a mediating factor in the relationship between service quality and EMR use (P < 0.05) as well as user satisfaction (P < 0.01). Among all the constructs, user satisfaction showed the strongest effect on perceived net-benefit of health professionals.ConclusionEMR implementers and managers in developing countries are in urgent need of implementation models to design proper implementation strategies. In this study, the constructs and relationships depicted in the updated D&M model were found to be applicable to assess the success of EMR in low resource settings. Additionally, computer literacy was found to be a mediating factor in EMR use and user satisfaction of health professionals. Hence, EMR implementers and managers in those settings should give priority in improving service quality of the hospitals like technical support and infrastructure; providing continuous basic computer trainings to health professionals; and give attention to the system and information quality of the systems they want to implement.

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

“…Theoretical frameworks and technology adoption models were applied and tested in several studies. One provided empirical data about the relevance of the DeLone and MacLean (D&M) information system success model in the context of EMR implementation in low‐resource settings . The D&M model is one of the most widely accepted and used models for assessing success of information systems.…”

“…One provided empirical data about the relevance of the DeLone and MacLean (D&M) information system success model in the context of EMR implementation in low-resource settings. 16 The D&M model is one of the most widely accepted and used models for assessing success of information systems. The constructs and relationships from the updated D&M model were found applicable for assessing the success of EMRs in low-resource settings.…”

Evaluation of Implementation E-Government with Delone and Mclean

“…This variable is used to measure the desired characteristics of the system [13]. Previous studies have shown that system quality has an influence on user satisfaction [11], [14].…”

Trends, Findings, and Opportunities: An Archival Review of Health Information Systems Research in Nigeria

“…The demands placed on healthcare professionals and organizations to deliver timely and cost effective healthcare services have resulted in the increased adoption of Health Information Systems (HIS) on a global scale (Tilahun & Fritz, 2015). Defined as "any system that captures, stores, manages or transmits information related to the health of individuals or the activities of organizations that work within the health sector" (Aghajari, Hassankhani, & Shaykhalipour 2013, p. 536), HIS are changing how healthcare services are being delivered, with the World Health Organisation listing HIS as a key building block for strong health systems (World Heallth Organization, 2007).…”

“…Defined as "any system that captures, stores, manages or transmits information related to the health of individuals or the activities of organizations that work within the health sector" (Aghajari, Hassankhani, & Shaykhalipour 2013, p. 536), HIS are changing how healthcare services are being delivered, with the World Health Organisation listing HIS as a key building block for strong health systems (World Heallth Organization, 2007). As a result, many international and humanitarian agencies are investing vast amounts of money to improve HIS in developing countries (Tilahun & Fritz, 2015). This stems from the expectation that successfully implemented HIS have the ability to transform healthcare delivery.…”