Electronic Health Record Portal Adoption: a cross country analysis

Area of Science:

• Health Informatics
• Technology Adoption Models
• Cross-Cultural Healthcare Studies

Background:

• Understanding factors driving Electronic Health Record (EHR) portal adoption is crucial for healthcare system modernization.
• Investigating cross-country differences in EHR portal adoption can inform global health policy and technology implementation.

Purpose of the Study:

• To identify the key determinants of user adoption of Electronic Health Record (EHR) portals.
• To compare EHR portal adoption factors between countries with distinct healthcare systems, specifically the United States and Portugal.

Main Methods:

• An extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model, incorporating the Concern for Information Privacy (CFIP) framework, was employed.
• Partial Least Squares (PLS) - Structural Equation Modeling (SEM) was utilized to analyze data from 597 valid online questionnaire responses collected in the US and Portugal.

Main Results:

• Performance expectancy, effort expectancy, social influence, hedonic motivation, price value, and habit significantly predicted behavioral intention to use EHR portals.
• Habit and behavioral intention were significant predictors of actual EHR portal use.
• Social influence, hedonic motivation, and price value uniquely influenced adoption in the US, unlike in Portugal. The model explained 53% of the variance in behavioral intention and 36% in use behavior.

Conclusions:

• Key factors influencing EHR portal adoption were identified, with significant cross-country variations observed.
• Contrary to potential concerns, confidentiality issues did not emerge as a significant barrier to EHR portal acceptance in this study.
• EHR portal usage rates were found to be substantially higher in the United States compared to Portugal, highlighting differences in adoption patterns across healthcare models.