Expectation-Confirmation Theory: Examining Physician Perceptions Toward EHR/EMR in Private Practice

The goal of this study was to fill a gap in literature explaining the relationships between physician perceptions and the continued use of electronic health records/electronic medical records (EHR/EMR) in private practice in the United States. The expectation-confirmation theory was extended to include the construct of institutional trust to explain physicians' continued use of health information technology (HIT) in the ambulatory setting. The main research question is, "What is the relationship between physician perceptions and the continued use of EHR/ EMR systems in private medical practices in the United States?" The business of medicine in the United States is strongly affected by federal legislation demanding the use of HIT along the patient care continuum. By investigating perception barriers to postadoption continuance intention through the utilization of HIT (e.g., EHR/EMR), practice managers and administrators can develop strategies to mitigate unfavorable perceptions. Reducing barriers may also promote continued utilization and innovation of HIT to remain competitive in the changing landscape of healthcare. This nonexperimental quantitative study tested five hypotheses centered on attitudes of 67 licensed United States. private practice physicians currently using an EHR/EMR. Descriptive statistics and multiple regression analysis tested data collected from a 25-item questionnaire. Findings revealed satisfaction has the strongest direct relationship to continued use of EHR/EMR. Perceived usefulness and institutional trust demonstrated strong direct relationships with continued use; however, perceived ease of use demonstrated a very weak direct relationship to EHR/EMR continued use. Future research could investigate continued use testing a larger sample of providers to generalize findings to the physician population, for investigating other high volume users of EHR/EMR such as nurses, nonclinical providers, and patients as population samples to see how attitudes differ from those of physicians. Including physician practice characteristics as moderating variables could deepen the understanding of generational, practice type, or practice size variances in users' continuance usage. By understanding the extent that continuance intention relates to trust in systems, satisfaction, and the system's usefulness and ease of use, the research offered in the present study will fill a gap in knowledge.