Adoption of clinical decision support systems in a developing country: Antecedents and outcomes of physician's threat to perceived professional autonomy

OBJECTIVE The basic objective of this research is to study the antecedents and outcomes of professional autonomy which is a central construct that affects physicians' intention to adopt clinical decision support systems (CDSS). The antecedents are physicians' attitude toward knowledge sharing and interactivity perception (about CDSS) and the outcomes are performance expectancy and intention to adopt CDSS. Besides, we include (1) the antecedents of attitude toward knowledge sharing-subjective norms, social factors and OCB (helping behavior) and (2) roles of physicians' involvement in decision making, computer self-efficacy and effort expectancy in our framework. METHODS Data from a stratified sample of 335 Malaysian physicians working in 12 public and private hospitals in Malaysia were collected to test the hypotheses using Structural Equation Modeling (SEM). RESULTS The important findings of our research are: (1) factors such as perceived threat to professional autonomy, performance expectancy, and physicians' involvement in making decision about CDSS have significant impact on physicians' intention to adopt CDSS; (2) physicians' attitude toward knowledge sharing, interactivity perception and computer self-efficacy of physicians play a crucial role in influencing their perceived threat to professional autonomy; and (3) social network, shared goals and OCB (helping behavior) impact physicians' attitude toward knowledge sharing. CONCLUSIONS The findings provide a comprehensive understanding of the factors that influence physicians' intention to adopt CDSS in a developing country. The results can help hospital managers manage CDSS implementation in an effective manner.

[1]  Sang M. Lee,et al.  An Empirical Study of the Relationships among End-User Information Systems Acceptance, Training, and Effectiveness , 1995, J. Manag. Inf. Syst..

[2]  Cara B. Litvin,et al.  Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care , 2012, Int. J. Medical Informatics.

[3]  Tsu-Ming Yeh,et al.  The effects of information sharing and interactivity on the intention to use social networking websites , 2013, Quality & Quantity.

[4]  H. Jochemsen,et al.  Professional Autonomy and the Normative Structure of Medical Practice , 2000, Theoretical medicine and bioethics.

[5]  Ephraim R. McLean,et al.  The DeLone and McLean Model of Information Systems Success: A Ten-Year Update , 2003, J. Manag. Inf. Syst..

[6]  F. Requena,et al.  Social Capital, Satisfaction and Quality of Life in the Workplace , 2003 .

[7]  Kwok Kee Wei,et al.  Social relationship and its role in knowledge management systems usage , 2009, Inf. Manag..

[8]  Luiz Augusto Facchini,et al.  Health information technology in primary health care in developing countries: a literature review. , 2004, Bulletin of the World Health Organization.

[9]  Olivia R. Liu Sheng,et al.  Adoption of Telemedicine Technology by Health Care Organizations: An Exploratory Study , 2002, J. Organ. Comput. Electron. Commer..

[10]  W. S. Chow,et al.  Social network, social trust and shared goals in organizational knowledge sharing , 2008, Inf. Manag..

[11]  Marie-Pierre Gagnon,et al.  An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians , 2003, Int. J. Medical Informatics.

[12]  Snejina Michailova,et al.  Facilitating knowledge sharing in Russian and Chinese subsidiaries: the role of personal networks and group membership , 2004, J. Knowl. Manag..

[13]  R. Stafford,et al.  Electronic health records and clinical decision support systems: impact on national ambulatory care quality. , 2011, Archives of internal medicine.

[14]  Zhiping Walter,et al.  Physician acceptance of information technologies: Role of perceived threat to professional autonomy , 2008, Decis. Support Syst..

[15]  Jianhua Ma,et al.  U- And E-Service, Science and Technology , 2011 .

[16]  Tung-Ching Lin,et al.  Factors affecting pass-along email intentions (PAEIs): Integrating the social capital and social cognition theories , 2009, Electron. Commer. Res. Appl..

[17]  J. Holsinger,et al.  Physician professionalism for a new century , 2006, Clinical anatomy.

[18]  Wei-Na Lee,et al.  Antecedents and Consequences of Perceived Interactivity , 2002 .

[19]  Mun Y. Yi,et al.  Understanding information technology acceptance by individual professionals: Toward an integrative view , 2006, Inf. Manag..

[20]  Pouyan Esmaeilzadeh,et al.  Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study , 2012, BMC Medical Informatics and Decision Making.

[21]  Chia-Ching Chang,et al.  Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes , 2009, Int. J. Medical Informatics.

[22]  Marzia Zaman,et al.  E-business Technology and Strategy - International Conference, CETS 2010, Ottawa, Canada, September 29-30, 2010. Proceedings , 2010, CETS.

[23]  Gordon B. Davis,et al.  User Acceptance of Information Technology: Toward a Unified View , 2003, MIS Q..

[24]  Yan Xiao,et al.  A review and a framework of handheld computer adoption in healthcare , 2005, Int. J. Medical Informatics.

[25]  M. Huysman,et al.  Practices of managing knowledge sharing: towards a second wave of knowledge management , 2004 .

[26]  Jeffrey E. Kottemann,et al.  Decisional Conflict and User Acceptance of Multicriteria Decision-Making Aids , 1991 .

[27]  Fred D. Davis.  User Acceptance of Information Technology: System Characteristics, User Perceptions and Behavioral Impacts , 1993, Int. J. Man Mach. Stud..

[28]  I. Ajzen.  Nature and operation of attitudes. , 2001, Annual review of psychology.

[29]  Ingoo Han,et al.  Knowledge sharing behavior of physicians in hospitals , 2003, Expert Syst. Appl..

[30]  Rajiv Kohli,et al.  Managing customer relationships through E-business decision support applications: a case of hospital-physician collaboration , 2001, Decis. Support Syst..

[31]  Pouyan Esmaeilzadeh,et al.  Adoption of Technology Applications in Healthcare: The Influence of Attitude toward Knowledge Sharing on Technology Acceptance in a Hospital , 2011, FGIT-UNESST.

[32]  Paul Jen-Hwa Hu,et al.  Examining a Model of Information Technology Acceptance by Individual Professionals: An Exploratory Study , 2002, J. Manag. Inf. Syst..

[33]  Michael H. Zack,et al.  Interactivity and Communication Mode Choice in Ongoing Management Groups , 1993, Inf. Syst. Res..

[34]  Chieh-Peng Lin,et al.  Clarifying the Relationship Between Organizational Citizenship Behaviors, Gender, and Knowledge Sharing in Workplace Organizations in Taiwan , 2008 .

[35]  Fay Cobb Payton,et al.  Lessons learned from three interorganizational health care information systems , 2000, Inf. Manag..

[36]  Tsai-Hsin Chu,et al.  Exploring knowledge contribution from an OCB perspective , 2007, Inf. Manag..

[37]  Poornima Madhavan,et al.  Effects of computer self-efficacy and system reliability on user interaction with decision support systems , 2010, Comput. Hum. Behav..

[38]  Alain Venot,et al.  Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics. , 2014, Journal of the American Medical Informatics Association : JAMIA.

[39]  Pouyan Esmaeilzadeh,et al.  The effect of knowledge sharing on technology acceptance among physicians , 2013 .

[40]  D. Organ.  Organizational Citizenship Behavior: It's Construct Clean-Up Time , 1997 .

[41]  Haralambos Mouratidis,et al.  Website Design Guidelines: High Power Distance and High-Context Culture , 2009 .

[42]  Joe Flower.  Digital technology essential and subversive. , 2004, Physician executive.

[43]  Pouyan Esmaeilzadeh,et al.  A Duel between Clinical Decision Support System and Healthcare Professionals: A Study in Malaysia , 2012 .

[44]  J. Coleman,et al.  Social Capital in the Creation of Human Capital , 1988, American Journal of Sociology.

[45]  William R. King,et al.  An integrated architecture for an effective knowledge organization , 2008, J. Knowl. Manag..

[46]  R. Gardner.  Computerized clinical decision-support in respiratory care. , 2004, Respiratory care.

[47]  William R. King,et al.  A meta-analysis of the technology acceptance model , 2006, Inf. Manag..

[48]  Sonja Wiley-Patton,et al.  Does the extended technology acceptance model apply to physicians , 2003, 36th Annual Hawaii International Conference on System Sciences, 2003. Proceedings of the.

[49]  Margaret Williamson,et al.  Review paper: Computerized clinical decision support for prescribing: provision does not guarantee uptake , 2010, J. Am. Medical Informatics Assoc..

[50]  Micha Popper,et al.  Organizational Learning in a Hospital , 2000 .

[51]  Terry L. Besser,et al.  Social Capital and Participation in Community Improvement Activities by Elderly Residents in Small Towns and Rural Communities , 2009 .

[52]  SHYAM SUNDAR,et al.  Explicating Web Site Interactivity , 2003, Commun. Res..

[53]  Su-Chao Chang,et al.  An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical industry , 2008, Int. J. Medical Informatics.

[54]  Meredith Lawley,et al.  Factors influencing decision support system acceptance , 2013, Decis. Support Syst..

[55]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[56]  Pouyan Esmaeilzadeh,et al.  The Challenges and Issues Regarding E-Health and Health Information Technology Trends in the Healthcare Sector , 2010, CETS.

[57]  Richard D. Johnson,et al.  The Multilevel and Multifaceted Character of Computer Self-Efficacy: Toward Clarification of the Construct and an Integrative Framework for Research , 1998, Inf. Syst. Res..

[58]  Prodromos D. Chatzoglou,et al.  Using a modified technology acceptance model in hospitals , 2009, Int. J. Medical Informatics.

[59]  Patrick J. Rosopa,et al.  The Relative Validity of Inferences About Mediation as a Function of Research Design Characteristics , 2008 .

[60]  Stuart M. Speedie,et al.  Factors influencing health information technology adoption in Thailand's community health centers: Applying the UTAUT model , 2009, Int. J. Medical Informatics.

[61]  Deborah Compeau,et al.  Social Cognitive Theory and Individual Reactions to Computing Technology: A Longitudinal Study , 1999, MIS Q..

[62]  I-Chiu Chang,et al.  Physicians' acceptance of pharmacokinetics-based clinical decision support systems , 2007, Expert Syst. Appl..

[63]  I. Nonaka,et al.  The Knowledge Creating Company , 2008 .

[64]  I. Ajzen,et al.  Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research , 1977 .

[65]  R. Sandstrom,et al.  The Meanings of Autonomy for Physical Therapy , 2007, Physical Therapy.

[66]  Daniel G. Bachrach,et al.  Organizational Citizenship Behaviors: A Critical Review of the Theoretical and Empirical Literature and Suggestions for Future Research , 2000 .

[67]  Mara Gorli,et al.  Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study , 2014, Implementation Science.

[68]  Wouter Duyck,et al.  Assessing Hospital Physicians' Acceptance of Clinical Information Systems: A Review of the Relevant Literature , 2013 .

[69]  Young-Gul Kim,et al.  Breaking the Myths of Rewards: An Exploratory Study of Attitudes about Knowledge Sharing , 2002, Inf. Resour. Manag. J..

[70]  K. Kälble.  Between professional autonomy and economic orientation — The medical profession in a changing health care system , 2005, Psycho-social medicine.

[71]  Eric T. G. Wang,et al.  Understanding knowledge sharing in virtual communities: An integration of social capital and social cognitive theories , 2006, Decis. Support Syst..

[72]  Manuel Lowenhaupt.  Removing barriers to technology. , 2004, Physician executive.

[73]  I. Ajzen.  The theory of planned behavior , 1991 .

[74]  Rolph E. Anderson,et al.  Multivariate Data Analysis with Readings , 1979 .

[75]  Adam Wright,et al.  Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study , 2012, BMC Medical Informatics and Decision Making.