title: Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.
abstract: BACKGROUND
  In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups.
  
  
  METHODS
  The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model.
  
  
  RESULTS
  The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four categories of independent variables were associated with the mean difference in the perceptions.
  
  
  CONCLUSIONS
  Discrepant attitudes toward privacy and support among the three user groups are identified. Patients may require further education and communication regarding the system. Culturally fit e-Consent should be incorporated into the system to fully utilize the computing power of the Internet when also considering workload. The concern for misuse of EPRs might lead to low support among physicians. Highly readable EPR documents and managerial incentives for information exchange may improve system use.
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan. ericwang@mail.cmu.edu.tw.
authors.forename: Jong-Yi
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Taichung Veterans General Hospital, Taichung, Taiwan. hoyun@vghtc.gov.tw.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Ho
authors.affiliation: National Changhua University of Education, Changhua, Taiwan. andiechen02@gmail.com.
authors.forename: Jen-De
authors.initials: JD
authors.lastname: Chen
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan. skchai@mail.cmu.edu.tw.
authors.forename: Sinkuo
authors.initials: S
authors.lastname: Chai
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan. cjtai@mail.cmu.edu.tw.|Department of Otolaryngology, China Medical University Hospital, Taichung, Taiwan. cjtai@mail.cmu.edu.tw.
authors.forename: Chih-Jaan
authors.initials: CJ
authors.lastname: Tai
authors.affiliation: Department of Healthcare Administration and Institute of Biomedical Engineering and Material Science, Central Taiwan University of Science and Technology, Taichung, Taiwan, No. 666, Buzih Road, Beitun District, Taichung, 40601, Taiwan. yfchen@ctust.edu.tw.
authors.forename: Yung-Fu
authors.initials: YF
authors.lastname: Chen
mesh_terms: D001292:Attitude to Computers; D057286:Electronic Health Records; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D015203:Reproducibility of Results