A Model of Electronic Health Record Systems Adoption by Primary Healthcare Physicians in the Kingdom of Saudi Arabia

Abstract

Over the past several decades, Electronic Health Record (EHR) systems have become a goal for many governments as a key enabler for improving healthcare quality and reducing costs. Particularly, the implementation of EHR systems in primary healthcare has been a priority for many countries. This is due to their great potentials in enhancing healthcare systems and in more efficiently managing the healthcare needs of the populations. But in developing countries, such as the Kingdom of Saudi Arabia (KSA), EHR systems are still not widely adopted. However, current policy initiatives by the Ministry of Health are attempting major reforms in primary healthcare with EHR systems as a key component. In fact, it has been estimated that between 50% and 80% of EHR projects fail, with end users’ resistance usually a major contributing factor. In the KSA, many studies had identified user resistance as a major barrier to the successful implementation of EHR systems. Therefore, the aim of this research is to investigate factors that impact primary healthcare physicians’ decisions regarding adopting EHR systems. This research was conducted in two main phases. The first phase aimed at developing a framework of key factors that are important in affecting the adoption of EHR systems by primary healthcare physicians. Three major comprehensive literature reviews were performed as a basis for developing the appropriate framework: a systematic review of barriers to the adoption of EHR systems in the KSA, a review of theories and models of user adoption of IT and a review of prior theoretical models of physicians’ adoption of EHR systems. As a result, an integrated framework was proposed, which was composed of eight main factors, namely: perceived usefulness, perceived ease of use, computer self-efficacy, social influence, physician participation, perceived threat to physician autonomy, attitude toward using an EHR system, and confidentiality concerns. The proposed framework was validated and enhanced using a qualitative data triangulation methodology with two key groups of informants: (1) leaders and experts of EHR implementation in  the KSA, and (2) decision makers and physicians in primary healthcare. The findings of this phase revealed that all the proposed factors are important and influential for the adoption of EHR systems by physicians except confidentiality concerns, which appeared to be mitigated by trust. Also, an additional important factor which has not been examined in prior research was identified, namely: compatibility. Importantly, the findings from both groups were consistent with each other, providing evidence for the validity of the framework. The second phase of the research was conducted to investigate the relationships between the identified factors in order to develop an explanatory and prediction model of EHR adoption decisions by primary healthcare physicians. In order to ensure the accuracy of measures used to examine the identified factors, a measurement instrument was developed based on both the results of the qualitative study performed in the first stage of this research and previously validated measures in the literature. The reliability of the instrument was examined using a pilot study of 32 primary healthcare physicians. The final stage of the second phase involved a nationwide survey, in which the developed instrument was used to collect data from primary healthcare physicians in the KSA. A total of 243 valid responses were received and analysed using Structural Equation Modelling (SEM). The results of SEM analysis clearly showed a good fit of both the measurement instrument and the proposed model to the collected data, implying that they are both valid in measuring and predicting EHR adoption decisions. The key outcome of the second phase of this research revealed that most of the hypothesized relationships amon