Patients’ Acceptance towards a Web-Based Personal Health Record System: An Empirical Study in Taiwan

The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients’ intention to use PHR systems remain unclear. Based on physicians’ therapeutic expertise, we implemented a web-based infertile PHR system and proposed an extended Technology Acceptance Model (TAM) that integrates the physician-patient relationship (PPR) construct into TAM’s original perceived ease of use (PEOU) and perceived usefulness (PU) constructs to explore which factors will influence the behavioral intentions (BI) of infertile patients to use the PHR. From ninety participants from a medical center, 50 valid responses to a self-rating questionnaire were collected, yielding a response rate of 55.56%. The partial least squares (PLS) technique was used to assess the causal relationships that were hypothesized in the extended model. The results indicate that infertile patients expressed a moderately high intention to use the PHR system. The PPR and PU of patients had significant effects on their BI to use PHR, whereas the PEOU indirectly affected the patients’ BI through the PU. This investigation confirms that PPR can have a critical role in shaping patients’ perceptions of the use of healthcare information technologies. Hence, we suggest that hospitals should promote the potential usefulness of PHR and improve the quality of the physician-patient relationship to increase patients’ intention of using PHR.

[1]  Heikki Karjaluoto,et al.  Consumer acceptance of online banking: an extension of the technology acceptance model , 2004, Internet Res..

[2]  Fred D. Davis,et al.  User Acceptance of Computer Technology: A Comparison of Two Theoretical Models , 1989 .

[3]  Waegemann Cp The five levels of electronic health records. , 1996 .

[4]  Y. Kowitlawakul The Technology Acceptance Model: Predicting Nurses' Intention to Use Telemedicine Technology (eICU) , 2011, Computers, informatics, nursing : CIN.

[5]  Julie A. Wolter,et al.  Defining the personal health record. AHIMA releases definition, attributes of consumer health record. , 2005, Journal of AHIMA.

[6]  Joost B L Hoekstra,et al.  Patients' Perception and Future Acceptance of an Artificial Pancreas , 2010, Journal of diabetes science and technology.

[7]  William B. Lober,et al.  Usage Patterns of a Personal Health Record by Elderly and Disabled Users , 2007, AMIA.

[8]  T. Wischmann [Psychosocial aspects of fertility disorders]. , 2005, Der Urologe. Ausg. A.

[9]  D. S. Simpson,et al.  Evaluating a Spoken Dialogue System for recording clinical observations during an endoscopic examination , 2003, Medical informatics and the Internet in medicine.

[10]  M. Lau,et al.  An Evaluation of a Web-Based Diabetes Education Program Designed to Enhance Self-management Among Patients Living With Diabetes , 2012, Computers, informatics, nursing : CIN.

[11]  An Overview Of Consumer Perceptions And Acceptance As Well As Barriers And Potential Of Electronic Personal Health Records , 2011 .

[12]  Marion J. Ball,et al.  E-health: transforming the physician/patient relationship , 2001, Int. J. Medical Informatics.

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

[14]  Gary L. Kreps,et al.  Consumers’ Perceptions About and Use of the Internet for Personal Health Records and Health Information Exchange: Analysis of the 2007 Health Information National Trends Survey , 2010, Journal of medical Internet research.

[15]  E. Skinner,et al.  A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers. , 2011, Psychiatric services.

[16]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[17]  Warren J. Winkelman,et al.  Research Paper: Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded Theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness , 2005, J. Am. Medical Informatics Assoc..

[18]  Willingness to use telemedicine for psychiatric care. , 2004, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[19]  Martina Ziefle,et al.  Technology acceptability for medical assistance , 2010, 2010 4th International Conference on Pervasive Computing Technologies for Healthcare.

[20]  MELANIE D. LOGUE,et al.  Modeling Factors That Influence Personal Health Records Adoption , 2012, Computers, informatics, nursing : CIN.

[21]  C. Fornell,et al.  Evaluating structural equation models with unobservable variables and measurement error. , 1981 .

[22]  Richard G. Klein,et al.  Internet-Based Patient-Physician Electronic Communication Applications: Patient Acceptance and Trust , 2007 .

[23]  Garry Wei-Han Tan,et al.  Determinants of Mobile Learning Adoption: An Empirical Analysis , 2012, J. Comput. Inf. Syst..

[24]  Robert J. Vokurka,et al.  The empirical assessment of construct validity , 1998 .

[25]  Sue Moorhead,et al.  Building a personal health record from a nursing perspective , 2007, Int. J. Medical Informatics.

[26]  Detmar W. Straub,et al.  Trust and TAM in Online Shopping: An Integrated Model , 2003, MIS Q..

[27]  Fred D. Davis,et al.  A critical assessment of potential measurement biases in the technology acceptance model: three experiments , 1996, Int. J. Hum. Comput. Stud..

[28]  D. Lansky,et al.  The missing link: bridging the patient-provider health information gap. , 2005, Health affairs.

[29]  Mack Lipkin,et al.  The Medical Interview: Clinical Care, Education, and Research , 2011 .

[30]  Patricia Flatley Brennan,et al.  Factors affecting home care patients' acceptance of a web-based interactive self-management technology , 2011, J. Am. Medical Informatics Assoc..

[31]  Eddy Karnieli,et al.  A model of the willingness to use telemedicine for routine and specialized care , 2003, Journal of telemedicine and telecare.

[32]  Wynne W. Chin How to Write Up and Report PLS Analyses , 2010 .

[33]  T. Teo,et al.  Understanding Technology Acceptance in Pre-Service Teachers: A Structural-Equation Modeling Approach , 2009 .

[34]  Jen-Her Wu,et al.  What drives mobile commerce?: An empirical evaluation of the revised technology acceptance model , 2005, Inf. Manag..

[35]  Nigel H. Lovell,et al.  Patients' perceptions of a home telecare system , 2008, Int. J. Medical Informatics.

[36]  Bi-Kun Tsai,et al.  Relationships among Trust in Messages, Risk Perception, and Risk Reduction Preferences Based upon Avian Influenza in Taiwan , 2012, International journal of environmental research and public health.

[37]  Kevin B. Johnson,et al.  Personal health records: evaluation of functionality and utility. , 2002, Journal of the American Medical Informatics Association : JAMIA.

[38]  Peggy Nygren,et al.  Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis , 2006, The Annals of Family Medicine.

[39]  Min-Huei Hsu,et al.  Factors influencing consumer adoption of USB-based Personal Health Records in Taiwan , 2012, BMC Health Services Research.

[40]  K. H. Gulkesen,et al.  Usability of a web-based personal nutrition management tool , 2011, Informatics for health & social care.

[41]  K. Mandl,et al.  Patient-Centered Design of an Information Management Module for a Personally Controlled Health Record , 2010, Journal of medical Internet research.

[42]  A. Vingerhoets,et al.  Psychological aspects of in vitro fertilization: a review. , 1999, Social science & medicine.

[43]  Henry Been-Lirn Duh,et al.  A study on Singaporean women's acceptance of using mobile phones to seek health information , 2011, Int. J. Medical Informatics.

[44]  Bing Wu,et al.  Analysis of the Challenges Affecting E-healthcare Adoption in Developing Countries: A Case of Tanzania , 2010 .

[45]  James Stewart,et al.  Doctor-patient relationship as motivation and outcome: Examining uses of an Interactive Cancer Communication System , 2007, Int. J. Medical Informatics.

[46]  Rudolf R. Sinkovics,et al.  The Use of Partial Least Squares Path Modeling in International Marketing , 2009 .

[47]  C P Waegemann,et al.  The five levels of electronic health records. , 1996, M.D. computing : computers in medical practice.

[48]  Richard Friedman,et al.  The prevalence and predictability of depression in infertile women. , 1992, Fertility and sterility.

[49]  A. Scott The economics of general practice. , 1984, The Medical journal of Australia.

[50]  John S Hargreaves,et al.  Will electronic personal health records benefit providers and patients in rural America? , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[51]  David W. Bates,et al.  Viewpoint Paper: A Research Agenda for Personal Health Records (PHRs) , 2008, J. Am. Medical Informatics Assoc..

[52]  Chia‐Fen Tsai,et al.  Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. , 2004, Human reproduction.

[53]  Adam Wright,et al.  Technical Brief: Encryption Characteristics of Two USB-based Personal Health Record Devices , 2007, J. Am. Medical Informatics Assoc..

[54]  L. Weng,et al.  Depression and somatic symptoms scale: A new scale with both depression and somatic symptoms emphasized , 2006, Psychiatry and clinical neurosciences.

[55]  Alexander H. Krist,et al.  Designing a patient-centered personal health record to promote preventive care , 2011, BMC Medical Informatics Decis. Mak..

[56]  Gaby Odekerken-Schröder,et al.  Using PLS path modeling for assessing hierarchial construct models: guidelines and impirical illustration , 2009 .

[57]  L. Ost Applied relaxation: description of a coping technique and review of controlled studies. , 1987, Behaviour research and therapy.

[58]  Chorng-Shyong Ong,et al.  Factors affecting engineers' acceptance of asynchronous e-learning systems in high-tech companies , 2004, Inf. Manag..

[59]  G. Eysenbach,et al.  The Impact of CyberHealthcare on the Physician–Patient Relationship , 2003, Journal of Medical Systems.

[60]  Yajiong Xue,et al.  Online health information seeking by people with physical disabilities due to neurological conditions , 2011, Int. J. Medical Informatics.

[61]  J. Hendriks,et al.  Current Internet use and preferences of IVF and ICSI patients. , 2003, Human reproduction.

[62]  C. Teutsch Patient-doctor communication. , 2003, The Medical clinics of North America.

[63]  Tresa Undem,et al.  Consumers and Health Information Technology: A National Survey , 2010 .

[64]  Younghwa Lee,et al.  The Technology Acceptance Model: Past, Present, and Future , 2003, Commun. Assoc. Inf. Syst..

[65]  R. Conigliaro,et al.  Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits , 2007 .

[66]  J. Dickinson,et al.  The economics of general practice , 1984, The Medical journal of Australia.

[67]  Daekil Kim,et al.  The role of trust in the use of health infomediaries among university students , 2012, Informatics for health & social care.

[68]  R. Casper,et al.  Use of the internet by infertile couples. , 2000, Fertility and sterility.