title: Information system end-user satisfaction and continuance intention: A unified modeling approach.
abstract: Permanent evaluation of end-user satisfaction and continuance intention is a critical issue at each phase of a clinical information system (CIS) project, but most validation studies are concerned with the pre- or early post-adoption phases.
  
  
  
  The purpose of this study was twofold: to validate at the Pompidou University Hospital (HEGP) an information technology late post-adoption model built from four validated models and to propose a unified metamodel of evaluation that could be adapted to each context or deployment phase of a CIS project.
  
  
  
  Five dimensions, i.e., CIS quality (CISQ), perceived usefulness (PU), confirmation of expectations (CE), user satisfaction (SAT), and continuance intention (CI) were selected to constitute the CI evaluation model. The validity of the model was tested using the combined answers to four surveys performed between 2011 and 2015, i.e., more than ten years after the opening of HEGP in July 2000. Structural equation modeling was used to test the eight model-associated hypotheses.
  
  
  
  The multi-professional study group of 571 responders consisted of 158 doctors, 282 nurses, and 131 secretaries. The evaluation model accounted for 84% of variance of satisfaction and 53% of CI variance for the period 2011-2015 and for 92% and 69% for the period 2014-2015. In very late post adoption, CISQ appears to be the major determinant of satisfaction and CI. Combining the results obtained at various phases of CIS deployment, a Unified Model of Information System Continuance (UMISC) is proposed.
  
  
  
  In a meaningful CIS use situation at HEGP, this study confirms the importance of CISQ in explaining satisfaction and CI. The proposed UMISC model that can be adapted to each phase of CIS deployment could facilitate the necessary efforts of permanent CIS acceptance and continuance evaluation.
authors.affiliation: INSERM - UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Pierre and Marie Curie University, Paris, France. Electronic address: brahim.hadji@crc.jussieu.fr.
authors.forename: Brahim
authors.initials: B
authors.lastname: Hadji
authors.affiliation: INSERM - UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Paris Descartes University, Paris, France. Electronic address: patrice.degoulet@aphp.fr.
authors.forename: Patrice
authors.initials: P
authors.lastname: Degoulet
mesh_terms: D006751:Hospital Information Systems; D006801:Humans; D033182:Intention; D008962:Models, Theoretical; D010549:Personal Satisfaction; D010820:Physicians; D011795:Surveys and Questionnaires
keywords: Clinical information system evaluation; Continuance intention; Information system acceptance; Information technology evaluation; Post-adoption evaluation; Structural equation modeling