Determinants of continuance intention in a post-adoption satisfaction evaluation of a clinical information system

Transcription

1 Determinants of continuance intention in a post-adoption satisfaction evaluation of a clinical information system Brahim Hadji, Isabelle Dupuis, Laurence Leneveut, Didier Heudes, Jean-François Wagner, Patrice Degoulet Paris 5 University & Pompidou University Hospital Istanbul, September 02, 2014

2 Plan Introduction Context The evaluation models Objectives of study Materials and Methods Results Discussion and conclusion 1

3 Introduction Context Evaluation of user satisfaction is an essential part of any CIS deployment and management project The evaluation dimensions should be adjusted to the CIS deployment phase and the end user profession Several IT evaluation models have been proposed both for acceptance and continuance intention [Van der Meijden MJ et al. J Am Med Inform Assoc 2003 ; 10 : ] [Holden RJ et al. J Biomed Inform 2010 ; 43 : ] [Pynoo B et al. Psychol Belg 2013 ; 53: ] 2

4 Evaluation models The Technology Acceptance Models (TAM) Acceptance models (pre-adoption, early deployment phases Unified Theory of Acceptance and Use of Technology (UTAUT) [Davis F. MIS Quarterly 1989; 13: ; Venkatesh V and Davis F. Manag. Sci ; 46: ] [Venkatesh, V. et al. Manag. Inf. Syst Q. 27.] 3

5 Evaluation models Continuance intention models (post adoption) The Expectation Confirmation Theory (ECT) The Expectation Confirmation Model of Information System Continuance (ECM-ISC) The ECT is widely used in the behavior literature to study consumer satisfaction and post-purchase behavior (i.e., repurchase intention) [Oliver RL. J Marketing Research (17), 1980, pp ]. [Bhattacherjee A. MIS Quarterly 2001; 25(3): ] 4

6 Objectives To propose an extended integrated Health IT Post-Adoption Model (ITPAM2) Based on the initial ITPAM (built on ECT and extended TAM with Perceived Usefulness and Perceived Ease of Use) [Palm JM et al. Stud Health Technol Inform. 2010;160 (Pt1):213-7] Adding a continuance intention dimension Measure and analyze the determinants of satisfaction and continuance intention in a late post-adoption deployment phase at HEGP CIS: DxCare/Medasys PACS : Agfa Biology: DxLab/Medasys 5

7 Material and Methods The HEGP clinical information system HEGP : 800 beds; acute care university hospital; CIS deployed at the opening (2000) admissions, discharge and transfer (ADT), electronic health records (EHR): laboratory reports, radiology reports and images, diagnostic test results computerized provider-order entry (CPOE) appointment and patient scheduling (APS) an integrated clinical data warehouse (CDW) The first three components are based on the DxCare software suite from Medasys, the fourth on OneCall from McKesson, and the fifth on i2b2. 6

8 Material and Methods Research hypotheses (ITPAM2) 7

9 Material and Methods Data and survey instrument Two surveys performed at HEGP (2011 & 2013) 52 questions for all health professional categories Satisfaction and continuance intention: Likert scales (1=Strongly disagree to 7=Strongly agree) Survey structures Nb. questions User characteristics 8 CIS Use 15 CIS Quality (information quality, compatibility with work, availability, ease of use) 11 Facilitating conditions (technical support, training) 4 CIS perceived usefulness 4 Confirmation of expectations 3 User satisfaction 2 Continuance intention 3 Free comments 2 Total 52 8

10 Results Respondents demographic characteristics MED NUR MDA Total p-value Sample size Male sex (%) < Full time activity (%) Mean age (SD) 46.0 (11,5) 36.3 (11.0) 40.6 (10.2) < (11.6) Seniority at work (SD) 7,69 (4,42) 6.99 (4.66) 7.89 (4.12) (4.49) 9

11 Results CIS function use 10

12 Results Satisfaction and continuance intention Sample size CIS quality Perceived CIS usefulness Confirmation of expectations Facilitating conditions User satisfaction Continuance intention MED NUR MDA Total p-value (1.28) 4.81 (1.63) 3.93 (1.46) 4.21 (1.34) 4.52 (1.66) 5.70 (1.41) 4.99 (0.93) 4.93 (1.14) 4.58 (1.14) 4.27 (1.30) 5.13 (1.12) 5.90 (0.99) 5.12 (0.90) 5.22 (0.99) 4.50 (1.01) 4.73 (1.24) 5.13 (1.09) 5.99 (0.93) < (1.04) (1.25) < (1.23) (1.31) (1.29) (1.10) 11

13 Résultats Hypothesis testing: determinants of satisfaction Dimension Hypothesis Simple regression r (p) Multiple regression r (p) Age (years) H (.217) (.574) Male sex (yes=1, no=0) H (.014).044 (.580) Medical profession (yes=1, no=0) H (<.0001) (.768) CIS quality H6.871 (<.0001).852 (<.0001) Facilitating conditions (user support & training) H7.495 (<.0001).034 (.229) Perceived CIS usefulness H8.636 (<.0001).074 (.027) Confirmation of expectations H9.693 (<.0001).174 (<.0001) Adjusted R2 (p-value).780 (<.0001) 12

14 Results Hypothesis testing: determinants of continuance intention Dimension Hypothesis Simple regression r (p) Multiple regression r (p) Age (years) H (.879).001 (.870) Male sex (yes=1, no=0) H (.153) (.927) Medical profession (yes=1, no=0) H (.071).062 (.5586) CIS quality H (<.0001).149 (.090) Perceived CIS usefulness H (<.0001).251 (<.0001) Confirmation of expectations H (<.0001).116 (.022) Global satisfaction H (.0001).140 (.046) Adjusted R2 (p-value).392 (<.0001) 13

15 Discussion and conclusion (1) Results summary Mean scores for all constructs were lower for medical professions than for nursing and medico-administrative categories of personnel Most CISs stress the key role of nurses and medical secretaries Physicians work under heavy time constraints Delegation from physicians to nurses and secretaries is an issue (i.e., CPOE drug orders) 14

16 Discussion and conclusion (2) Results summary In simple regressions the global satisfaction can be explained by the CIS quality, facilitating conditions, perceived CIS usefulness, and confirmation of expectations. In multiple regression global satisfaction is not influenced by facilitating conditions it has a larger influence in the initial phases of deployment than in the late post-adoption phases 15

17 Discussion and conclusion (3) Results summary In simple regressions the continuance intention was determined by, CIS quality, perceived CIS usefulness, confirmation of expectations and global satisfaction In multiple regression, the continuance intention is not influenced by the CIS quality dimension in a quasi-mandatory situation, end-users felt it necessary to pursue 16

18 Discussion and conclusions (4) Limits The survey responses rate is low (18.7%) The proposed model (ITPAM2) was tested only in one hospital Degree of use not considered in the explanation model Use was replaced by intent to continue to (better) use in the ITPAM2 model 17

19 Discussion and conclusions (5) Perspectives Testing the ITPAM2 model in various hospital environments Consider other determinants of continuance intention not present in the current survey. Using ITPAM2 to compare the user satisfaction and continuance intention evolution in the different phases of a CIS deployment and use 18

20 Thank you for your attention Contact: - brahim.hadji@crc.jussieu.fr - patrice.degoulet@egp.aphp.fr 19

21 Résultats Validité des instruments Evaluation des construits (Nb. Items) Cronbach s α Qualité SIC (4) 0,84 Utilité perçue (3) 0,88 Conditions facilitantes (support utilisateur) (2) 0,67 Confirmation des attentes (3) 0,95 Intention de continuer (3) 0,79

22 Sexe M **/* Médecin ***/N S ***/*** ***/NS Qualité du SIC Confirmation des attentes Support utilisateurs ***/*** Utilité perçue */N S ***/*** Satisfaction ***/*** ***/NS ***/ * ***/NS ***/*** ***/** ***/*** ***/NS Intention de continuer *** : p-value <.001 ** : p-value <.01 * : p-value <.05