title: Electronic health record acceptance by physicians: testing an integrated theoretical model.
abstract: OBJECTIVE
  Several countries are in the process of implementing an Electronic Health Record (EHR), but limited physicians' acceptance of this technology presents a serious threat to its successful implementation. The aim of this study was to identify the main determinants of physician acceptance of EHR in a sample of general practitioners and specialists of the Province of Quebec (Canada).
  
  
  METHODS
  We sent an electronic questionnaire to physician members of the Quebec Medical Association. We tested four theoretical models (Technology acceptance model (TAM), Extended TAM, Psychosocial Model, and Integrated Model) using path analysis and multiple linear regression analysis in order to identify the main determinants of physicians' intention to use the EHR. We evaluated the modifying effect of sociodemographic characteristics using multi-group analysis of structural weights invariance.
  
  
  RESULTS
  A total of 157 questionnaires were returned. The four models performed well and explained between 44% and 55% of the variance in physicians' intention to use the EHR. The Integrated model performed the best and showed that perceived ease of use, professional norm, social norm, and demonstrability of the results are the strongest predictors of physicians' intention to use the EHR. Age, gender, previous experience and specialty modified the association between those determinants and intention.
  
  
  CONCLUSIONS
  The proposed integrated theoretical model is useful in identifying which factors could motivate physicians from different backgrounds to use the EHR. Physicians who perceive the EHR to be easy to use, coherent with their professional norms, supported by their peers and patients, and able to demonstrate tangible results are more likely to accept this technology. Age, gender, specialty and experience should also be taken into account when developing EHR implementation strategies targeting physicians.
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada; Faculty of Nursing Sciences, Université Laval, 1050 avenue de la Médecine, Quebec City, Quebec G1V 0A6, Canada. Electronic address: marie-pierre.gagnon@fsi.ulaval.ca.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada.
authors.forename: El Kebir
authors.initials: el K
authors.lastname: Ghandour
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada.
authors.forename: Pascaline Kengne
authors.initials: PK
authors.lastname: Talla
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Simonyan
authors.affiliation: Faculty of Nursing Sciences, Université Laval, 1050 avenue de la Médecine, Quebec City, Quebec G1V 0A6, Canada.
authors.forename: Gaston
authors.initials: G
authors.lastname: Godin
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.affiliation: Research Center of the CHU de Québec. 10 rue de l'Espinay, Quebec City, Quebec G1L 3L5, Canada; Department of Political Science, Université Laval, 1030, avenue des Sciences-Humaines, Quebec City, Quebec G1V 0A6, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Ouimet
authors.affiliation: Department of Psychoeducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, C.P. 500, Trois-Rivières, Quebec G9A 5H7, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Rousseau
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003657:Decision Making; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010820:Physicians / Q000523:psychology*; D011594:Psychometrics; D011792:Quebec; D012044:Regression Analysis; D012737:Sex Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires
keywords: Acceptance; Electronic health record; Physicians; TAM; Theoretical model