Abstract
An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users’ perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 ± 1,33). Their perception of the ease of use of the system (mean 5,04 ± 1,41), usefulness (mean 4,69 ± 1,35) and facilitating conditions (4,43 ± 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.
Similar content being viewed by others
References
Garg, A. X., Adhikari, N. K., McDonald, H., et al., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: A systematic review. JAMA 293:1223–1238, 2005.
Eccles, M., and Grimshaw, J., Selecting, presenting and delivering clinical guidelines: Are there any “magic bullets”? Med. J. Aust. 180(Suppl 6):S52–S54, 2004.
Johnston, M. E., Langton, K. B., Haynes, R. B., and Mathieu, A., Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann. Intern. Med. 120:136–142, 1994.
Shea, S., DuMouchel, W., and Bahamonde, L., A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. JAMIA 3:399–409, 1996.
Heselmans, A., Van de Velde, S., Donceel, P., Aertgeerts, B., and Ramaekers, D., Effectiveness of electronic guideline-based implementation systems in ambulatory care settings—a systematic review. Implement. Sci. 4:82, 2009.
Shojania, K. G., Jennings, A., Mayhew, A., Ramsay, C., Eccles, M., and Grimshaw, J., Effect of point-of-care computer reminders on physician behaviour: A systematic review. CMAJ 182:E216–E225, 2010.
Venkatesh, V., Morris, M., and Davis, G., User acceptance of information technology: toward a unified view. MIS Quart. 27:425–478, 2003.
Wills, M. J., El-Gayar, O. F., and Bennett, D., Examining healthcare professionals’ acceptance of electronic medical records using UTAUT. Issues in Information Systems 9:396–401, 2008.
Schaper, L., and Pervan, G., A model of information and communication technology acceptance and utilisation by occupational therapists. Stud. Health Technol. Inform. 130:91–101, 2007.
EBMeDS : Context-Sensitive Guidance At the Point of Care. http://www.ebmeds.org. Accessed 13 November 2011
Varonen, H., Kortteisto, T., and Kaila, M., What may help or hinder the implementation of computerized decision support systems (CDSSs): A focus group study with physicians. Fam. Pract. 25:162–167, 2008.
Rousseau, N., McColl, E., Newton, J., Grimshaw, J., and Eccles, M., Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care. BMJ 326:314, 2003.
Bates, D. W., Kuperman, G. J., Wang, S., et al., Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. J. Am. Med. Inform. Assoc. 10:523–530, 2003.
Trivedi, M. H., Daly, E. J., Kern, J. K., Grannemann, B. D., Sunderajan, P., and Claassen, C. A., Barriers to implementation of a computerized decision support system for depression: An observational report on lessons learned in “real world” clinical settings. BMC Med. Inform. Decis. Mak. 9:6, 2009.
Ahearn, M. D., and Kerr, S. J., General practitioners’ perceptions of the pharmaceutical decision-support tools in their prescribing software. Med. J. Aust. 179:34–37, 2003.
Vaziri, A., Connor, E., Shepherd, I., Jones, R. T., Chan, T., and de Lusignan, S., Are we setting about improving the safety of computerised prescribing in the right way? Inform. Prim. Care 17:175–182, 2009.
van der Sijs, H., Aarts, J., Vulto, A., and Berg, M., Overriding of drug safety alerts in computerized physician order entry. J. Am. Med. Inform. Assoc. 13:138–147, 2006.
Acknowledgment
We would like to thank all the family physicians who took part in this study and are grateful to all experts of SoSoeMe who created the possibilities to perform the study.
Conflict of Interest
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Heselmans, A., Aertgeerts, B., Donceel, P. et al. Family Physicians’ Perceptions and Use of Electronic Clinical Decision Support During the First Year of Implementation. J Med Syst 36, 3677–3684 (2012). https://doi.org/10.1007/s10916-012-9841-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10916-012-9841-3