title: A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.
abstract: BACKGROUND
  There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations.
  
  
  OBJECTIVE
  We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model.
  
  
  METHODS
  We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques.
  
  
  RESULTS
  We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers.
  
  
  CONCLUSIONS
  Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.
authors.affiliation: DeGroote School of Business, McMaster University, Hamilton, ON, Canada. archer@mcmaster.ca
authors.forename: Norm
authors.initials: N
authors.lastname: Archer
authors.forename: Mihail
authors.initials: M
authors.lastname: Cocosila
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D002170:Canada; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011216:Practice Management, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires