A framework for examining relationships among electronic health record (EHR) system design, implementation, physicians' work impact

In the current healthcare industry, physicians' resistance toward healthcare information technology (HIT) adoption and mixed result of impact that electronic health record (EHR) brings to physicians' work have always been a concern. This study have achieved the following three primary objectives: (1) build and contextualize a socio-technical evaluation model to assess the interaction between EHR and physician; (2) identify critical factors of EHR system design and organizational support as determinants of physicians' acceptance of EHR; (3) assess the impacts of EHR on physicians' work.;Survey methodology was employed in this study and a questionnaire based on the literature review was designed to evaluate the framework. The survey sample is 219 residents of any specialty from diverse residency programs located in California. The survey data is analyzed using multiple regression analysis and structural equation modeling to investigate the interdependent relationships among constructs in the our model, which is named as EHR Success Model. This EHR Success Model conceptualizes and operationalizes Delone and Mclean (D&M)'s IS success measures in the context of HIT for the first time. And it goes beyond previous models and evaluation studies in three important ways. First, the model and its measures are contextualized in physicians' work patterns; when physicians fill out the survey, they could understand the questions better and connect the scenarios described in the questions to their real work, so we get more accurate measurements and more validated result. Second, EHR Success Model includes work impact measures as the final dependent variables, rather than intention to use, which is often the case in most of the previous information system studies. It also performs well in predicting most of the work impact measures and could explain up to 42% of the variance in the work impact measures; therefore, it could be utilized as diagnostic tool to assess EHR implementation success and guide system designers and hospital administrators to design more desirable system and environment with the ultimate objective to improve physicians' work. Third, the process of EHR Success Model validation examines the relationships between constructs and highlights the importance of the technology task fit construct, which provides deeper insights in understanding what of and how EHR lead to physicians' work impact from a systematic perspective.