title: Electronic alerts and clinician turnover: the influence of user acceptance.
abstract: OBJECTIVE
  Use of certain components of electronic health records (EHRs), such as EHR-based alerting systems (EASs), might reduce provider satisfaction, a strong precursor to turnover. We examined the impact of factors likely to influence providers' acceptance of an alerting system, designed to facilitate electronic communication in outpatient settings, on provider satisfaction, intentions to quit, and turnover.
  
  
  METHODS
  We conducted a cross-sectional Web-based survey of EAS-related practices from a nationwide sample of primary care providers (PCPs) practicing at Department of Veterans Affairs (VA) medical facilities. Of 5001 invited VA PCPs, 2590 completed the survey. We relied on Venkatesh's Unified Theory of Acceptance and Use of Technology to create survey measures of 4 factors likely to impact user acceptance of EAS: supportive norms, monitoring/ feedback, training, and providers' perceptions of the value (PPOV) of EASs to provider effectiveness. Facility-level PCP turnover was measured via the VA's Service Support Center Human Resources Cube. Hypotheses were tested using structural equation modeling.
  
  
  RESULTS
  After accounting for intercorrelations among predictors, monitoring/feedback regarding EASs significantly predicted intention to quit (b = 0.30, P < .01), and PPOV of EASs predicted both overall provider satisfaction (b = 0.58, P < .01) and facility-level provider turnover levels (b = -0.19, P < .05), all without relying on any intervening mechanisms.
  
  
  CONCLUSIONS
  Design, implementation, and use of EASs might impact provider satisfaction and retention. Institutions should consider strategies to help providers perceive greater value in these clinical tools.
authors: Center for Innovations in Quality, Effectiveness and Safety (152), Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030. E-mail: hysong@bcm.edu.
authors: Sylvia J
authors: SJ
authors: Hysong
authors: Christiane
authors: C
authors: Spitzmuller
authors: Donna
authors: D
authors: Espadas
authors: Dean F
authors: DF
authors: Sittig
authors: Hardeep
authors: H
authors: Singh
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs