title: Physicians' acceptance of electronic medical records exchange: an extension of the decomposed TPB model with institutional trust and perceived risk.
abstract: OBJECTIVE
  Electronic medical records (EMRs) exchange improves clinical quality and reduces medical costs. However, few studies address the antecedent factors of physicians' intentions to use EMR exchange. Based on institutional trust and perceived risk integrated with the decomposed theory of planned behavior (TPB) model, we propose a theoretical model to explain the intention of physicians to use an EMR exchange system.
  
  
  METHODS
  We conducted a field survey in Taiwan to collect data from physicians who had experience using the EMR exchange systems. A valid sample of 191 responses was collected for data analysis. To test the proposed research model, we employed structural equation modeling using the partial least squares method.
  
  
  RESULTS
  The study findings show that the following five factors have a significant influence on the physicians' intentions to use EMR exchange systems: (a) attitude; (b) subjective norm; (c) perceived behavior control; (d) institutional trust; and (e) perceived risk. These five factors are predictable by perceived usefulness, perceived ease of use, and compatibility, interpersonal and governmental influence, facilitating conditions and self-efficacy, situational normality and structural assurance, and institutional trust, respectively. The results also indicate that institutional trust and perceived risk integrated with the decomposed TPB model improve the prediction of physician's intentions to use EMR exchange.
  
  
  CONCLUSIONS
  The results of this study indicate that our research model effectively predicts the intention of physicians to use EMR exchange, and provides valuable implications for academics and practitioners.
authors.affiliation: Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, No. 60, Section 1, Erren Rd., Rende Dist., Tainan 71710, Taiwan, ROC. Electronic address: beerun@seed.net.tw.
authors.forename: Pi-Jung
authors.initials: PJ
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013624:Taiwan; D035502:Trust; D055815:Young Adult
keywords: Acceptance process; Electronic medical records; Electronic medical records exchange; Health information technology