Appl Clin Inform 2015; 06(02): 224-247
DOI: 10.4338/ACI-2014-11-RA-0107
Research Article
Schattauer GmbH

Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health

A Cross-sectional Survey
K. Gartrell
1   National Institutes of Health/National Library of Medicine/Lister Hill National Center for Biomedical Communications, Bethesda, MD
,
A.M. Trinkoff
2   University of Maryland School of Nursing, Baltimore, MD
,
C.L. Storr
2   University of Maryland School of Nursing, Baltimore, MD
,
M.L. Wilson
3   Johns Hopkins University School of Nursing, Baltimore, MD
,
A.P. Gurses
4   Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD
› Author Affiliations
Further Information

Publication History

received: 20 November 2014

accepted: 24 February 2015

Publication Date:
19 December 2017 (online)

Summary

Background: To our knowledge, no evidence is available on health care professionals’ use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses’ personal use of ePHRs using a modified technology acceptance model.

Objectives: To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses’ own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers’ use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use.

Methods: A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect.

Results: Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses’ own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses.

Conclusions: Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their individual patients.

Citation: Gartrell K, Trinkoff AM, Storr CL, Wilson ML, Gurses AP. Testing the electronic personal health record acceptance model by nurses for managing their own health: A cross-sectional survey. Appl Clin Inf 2015; 6: 224–247

http://dx.doi.org/10.4338/ACI-2014-11-RA-0107

 
  • References

  • 1 News: Secretary Sebelius announces next stage for providers adopting electronic health records [Internet].. U. S. Department of Health & Human Services (DHHS). 2012 [updated 2014 Aug 25; cited 2014 Sep 27]. Available from: http://www.hhs.gov/news/press/2012pres/02/20120224a.html
  • 2 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504. doi:10.1056/NEJMp1006114.
  • 3 Eligible hospital and critical access hospital meaningful use core measures measure 6 of 16 stage 2.. Baltimore: Centers for Medicare & Medicaid Services; 2014 [updated 2014 Aug; cited 2014 Aug 27]. Available from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_HospitalCore_6_PatientElectronicAccess.pdf
  • 4 The national alliance for health information technology report to the office of the national coordinator for health information technology on defining key health information technology terms [Internet]. U. S. Department of Health and Human Services; 2008 [updated 2008 Apr 28; cited 2014 Sep 27]. Available from: http://www.nacua.org/documents/HealthInfoTechTerms.pdf
  • 5 The role of the personal health record in the EHR (updated) [Internet].. American Health Information Management Association; 2010 [updated 2010 Nov; cited 2014 Sep 27]. Available from: http://library.ahima.org/xpedio/idcplg?IdcService=GET_HIGHLIGHT_INFO&Query-Text=%28role+of+the+personal%29%3Cand%3E%28xPublishSite%3Csubstring%3E%60BoK%60%29&SortField=xPubDate&SortOrder=Desc&dDocName=bok1_048517&High-lightType=HtmlHighlight&dWebExtension=hcsp
  • 6 HIMSS personal health records definition and position statement [Internet].. Healthcare Information Management and Systems Society; 2007 [updated 2007 Sep 28; cited 2014 Sep 27]. Available from: http://himss.files.cms-plus.com/himssorg/content/files/phrdefinition071707.pdf
  • 7 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: Definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006; 13 (02) 121-126. doi:10.1197/jamia. M2025.
  • 8 Consumer health IT applications [Internet]. U. S. Department of Health & Human Services; 2013 [updated 2013 Nov; cited 2014 Sep 27]. Available from: http://healthit.ahrq.gov/key-topics/consumer-health-it-applications#six
  • 9 Davis Giardina T, Menon S, Parrish DE, Sittig DF, Singh H. Patient access to medical records and health-care outcomes: a systematic review. J Am Med Inform Assoc 2014; 21 (04) 737-741. doi: 10.1136/amiajnl-2013-002239.
  • 10 Kupchunas WR.. Personal health record: new opportunity for patient education. Orthop Nurs 2007; 26 (Suppl. 03) 185-91. quiz 192-193.
  • 11 Ant Ozok A, Wu H, Garrido M, Pronovost PJ, Gurses AP. Usability and perceived usefulness of personal health records for preventive health care: Patients’ and primary care providers’ perspectives. Appl Ergon 2014; 45 (03) 613-628. doi:10.1016/j.apergo.2013.09.005.
  • 12 Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele JE, Cunningham TD, Longo DR, Bello GA, Matzke GR. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Ann Fam Med 2012; 10 (04) 312-319. doi:10.1370/afm.1383.
  • 13 Nagykaldi Z, Aspy CB, Chou A, Mold JW. Impact of a Wellness Portal on the delivery of patient-centered preventive care. J Am Board Fam Med 2012; 25 (02) 158-167. doi: 10.3122/jabfm.2012.02.110130.
  • 14 Wright A, Poon EG, Wald J, Feblowitz J, Pang JE, Schnipper JL, Grant RW, Gandhi TK, Volk LA, Bloom A, Williams DH, Gardner K, Epstein M, Nelson L, Businger A, Li Q, Bates DW, Middleton B. Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PHR. J Gen Intern Med 2012; 27 (01) 85-92. doi: 10.1007/s11606–011–1859–6.
  • 15 Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res 2005; 40 6 Pt 1 1918-1930. doi: 10.1111/j.1475–6773.2005.00438.x.
  • 16 Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: A scoping review. J Am Med Inform Assoc 2011; 18 (04) 515-522. doi:10.1136/amiajnl-2011–000105.
  • 17 A community view on how personal health records can improve patient care and outcomes in many health care settings [Internet].. Northern Illinois Physicians for Connectivity (NIPFC) and Northern Illinois University Regional Development Institute (NIU RDI); 2009 [cited 2014 Sep 27]. Available from: http://www.mrccg.com/media/1627/personal_health_records_and_patient_care_2009.pdf
  • 18 Kahn JS, Aulakh V, Bosworth A. What it takes: characteristics of the ideal personal health record. Health Aff (Millwood) 2009; 28 (02) 369-376. doi: 10.1377/hlthaff.28.2.369.
  • 19 Fonda SJ, Kedziora RJ, Vigersky RA, Bursell SE. Combining iGoogle and personal health records to create a prototype personal health application for diabetes self-management. Telemed J E Health 2010; 16 (04) 480-489. doi:10.1089/tmj.2009.0122.
  • 20 Hess R, Bryce CL, Paone S, Fischer G, McTigue KM, Olshansky E, Zickmund S, Fitzgerald K, Siminerio L. Exploring challenges and potentials of personal health records in diabetes self-management: Implementation and initial assessment. Telemed J E Health 2007; 13 (05) 509-517.
  • 21 Grant RW, Wald JS, Schnipper JL, Gandhi TK, Poon EG, Orav EJ, Williams DH, Volk LA, Middleton B. Practice-linked online personal health records for type 2 diabetes mellitus: A randomized controlled trial. Arch Intern Med 2008; 168 (16) 1776-1782. doi:10.1001/archinte.168.16.1776.
  • 22 Tenforde M, Nowacki A, Jain A, Hickner J. The association between personal health record use and diabetes quality measures. J Gen Intern Med 2012; 27 (04) 420-424. doi:10.1007/s11606–011–1889–0.
  • 23 Lau M, Campbell H, Tang T, Thompson DJ, Elliott T. Impact of patient use of an online patient portal on diabetes outcomes. Can J Diabetes 2014; 38 (01) 17-21. doi: 10.1016/j.jcjd.2013.10.005.
  • 24 Zikmund-Fisher BJ, Exe NL, Witteman HO. Numeracy and literacy independently predict patients’ ability to identify out-of-range test results. J Med Internet Res 2014; 16 (08) e187. doi: 10.2196/jmir.3241.
  • 25 Day K, Gu Y. Influencing factors for adopting personal health record (PHR). Stud Health Technol Inform 2012; 178: 39-44.
  • 26 Cimino JJ, Patel VL, Kushniruk AW. The patient clinical information system (PatCIS): Technical solutions for and experience with giving patients access to their electronic medical records. Int J Med Inform 2002; 68 1–3 113-127.
  • 27 Mandl KD, Simons WW, Crawford WC, Abbett JM. Indivo: A personally controlled health record for health information exchange and communication. BMC Med Inform Decis Mak 2007; 7: 25. doi:10.1186/1472–6947–7–25.
  • 28 Wagner PJ, Howard SM, Bentley DR, Seol YH, Sodomka P. Incorporating patient perspectives into the personal health record: Implications for care and caring. Perspect Health Inf Manag 2010; 7: 1e.
  • 29 Yau GL, Williams AS, Brown JB. Family physicians’ perspectives on personal health records: Qualitative study. Can Fam Physician 2011; 57 (05) e178-e184.
  • 30 Tang PC, Lansky D. The missing link: Bridging the patient-provider health information gap. Health Aff (Millwood) 2005; 24 (05) 1290-1295. doi:10.1377/hlthaff.24.5.1290.
  • 31 Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S, Deitz D, Kuck S, Ortiz E. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc 2004; 11 (06) 505-513. doi:10.1197/jamia. M1593
  • 32 Ralston JD, Carrell D, Reid R, Anderson M, Moran M, Hereford J. Patient web services integrated with a shared medical record: patient use and satisfaction. J Am Med Inform Assoc 2007; 14 (06) 798-806.
  • 33 Fuji KT, Galt KA, Serocca AB. Personal health record use by patients as perceived by ambulatory care physicians in Nebraska and south Dakota: A cross-sectional study. Perspect Health Inf Manag 2008; 5: 15.
  • 34 Romano M, Gesualdo F, Pandolfi E, Tozzi AE, Ugazio AG. Use of the internet by Italian pediatricians: habits, impact on clinical practice and expectations. BMC Med Inform Decis Mak 2012; 12 (23) 1-7. doi:10.1186/1472–6947–12–23.
  • 35 Witry MJ, Doucette WR, Daly JM, Levy BT, Chrischilles EA. Family physician perceptions of personal health records. Perspect Health Inf Manag 2010; 7: 1d.
  • 36 Wynia MK, Torres GW, Lemieux J. Many physicians are willing to use patients’ electronic personal health records, but doctors differ by location, gender, and practice. Health Aff (Millwood) 2011; 30 (02) 266-273. doi:10.1377/hlthaff.2010.0342.
  • 37 Atkinson NL, Massett HA, Mylks C, Hanna B, Deering MJ, Hesse BW. User-centered research on breast cancer patient needs and preferences of an internet-based clinical trial matching system. J Med Internet Res 2007; 9 (02) e13. doi:10.2196/jmir.9.2.e13.
  • 38 Tracy CS, Dantas GC, Upshur RE. Feasibility of a patient decision aid regarding disclosure of personal health information: Qualitative evaluation of the health care information directive. BMC Med Inform Decis Mak. 2004 4. 13 doi:10.1186/1472–6947–4-13.
  • 39 Kahn JS, Hilton JF, Van Nunnery T, Leasure S, Bryant KM, Hare CB, Thom DH. Personal health records in a public hospital: Experience at the HIV/AIDS clinic at San Francisco general hospital. J Am Med Inform Assoc 2010; 17 (02) 224-228. doi:10.1136/jamia.2009.000315.
  • 40 Kim MI, Johnson KB. Patient entry of information: Evaluation of user interfaces. Journal of Medical Internet Research 2004; 6 (02) e13. doi:10.2196/jmir.6.2.e13.
  • 41 Lober WB, Zierler B, Herbaugh A, Shinstrom SE, Stolyar A, Kim EH, Kim Y. Barriers to the use of a personal health record by an elderly population. Proceedings of the Annual AMIA Symposium; 2006: 514-518.
  • 42 Noblin AM, Wan TT, Fottler M. The impact of health literacy on a patient’s decision to adopt a personal health record. Perspect Health Inf Manag 2012; 9: 1-13.
  • 43 PHR adoption on the rise [Internet].. New York: Markle Foundation; 2011 [updated 2011 Jan 31; cited 2014 Sep 27]. Available from: http://www.markle.org/publications/1440-phr-adoption-rise
  • 44 Thede L. Informatics: Electronic personal health records: Nursing’s role. Online Journal of Issues in Nursing [Internet]. 2008 [cited 2014 Sep 29];14(1). doi:10.3912/OJIN. Vol14No1InfoCol01. Available from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/Electronic-Personal-Health-Records.html
  • 45 Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly 1989; 13 (03) 319-340.
  • 46 Holden R, Karsh B. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010; 43 (01) 159-172. doi:10.1016/j.jbi.2009.07.002.
  • 47 Chismar WG, Wiley-Patton S. Does the extended technology acceptance model apply to physicians. Proceedings of the 36th Annual Hawaii International Conference on System Sciences (HICSS’03) –Track 6 –Volume 6 (HICSS ’03). Hawaii; 2003 IEEE Computer Society. Washington, DC, USA: 2003: 160.
  • 48 Dixon DR, Stewart M. Exploring information technology adoption by family physicians: Survey instrument valuation. Proceedings of the Annual AMIA Symposium; 2000: 185-189.
  • 49 Liang H, Xue Y, Byrd TA. PDA usage in health care professionals: Testing an Extended technology acceptance model. Int J Mob Commun 2003; 1 (04) 372-389. doi:10.1504/IJMC.2003.003992.
  • 50 Paré G, Sicotte C, Jacques H. The effects of creating psychological ownership on physicians’ acceptance of clinical information systems. J Am Med Inform Assoc 2006; 13 (02) 197-205. doi:10.1197/jamia. M1930.
  • 51 Van Schaik P, Bettany-Saltikov J, Warren JG. Clinical acceptance of a low-cost portable system for postural assessment. Behaviour & Information Technology 2002; 21 (01) 47-57. doi:10.1080/01449290110107236.
  • 52 Schnall R, Bakken S. Testing the technology acceptance model: HIV case managers’ intention to use a continuity of care record with context-specific links. Inform Health Soc Care 2011; 36 (03) 161-172. doi:10.3109/17538157.2011.584998.
  • 53 Liu L, Ma Q. Perceived system performance: A test of an extended technology acceptance model. SIGMIS Database 2006; 37 2–3 51-59. doi:10.1145/1161345.1161354.
  • 54 Lu CH, Hsiao JL, Chen RF. Factors determining nurse acceptance of hospital information systems. Comput Inform Nurs 2012; 30 (05) 257-264. doi:10.1097/NCN.0b013e318224b4cf.
  • 55 Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: A technology acceptance model 2 approach. Comput Inform Nurs 2010; 28 (01) 49-56. doi:10.1097/NCN.0b013e3181c0474a.
  • 56 Wu JH, Wang SC, Lin LM. Mobile computing acceptance factors in the health care industry: A structural equation model. Int J Med Inform 2007; 76 (01) 66-77. doi:10.1016/j.ijmedinf.2006.06.006.
  • 57 Rogers EM. Diffusion of innovations. 4th ed. New York: Free Press; 1995: 519 p.
  • 58 Moore GC, Benbasat I. Development of an instrument to measure the perceptions of adopting an information technology innovation. Information Systems Research 1991; 2 (03) 192-222.
  • 59 Consumers and health information technology: A national survey [Internet].. Oakland: California Health Care Foundation; 2010 [updated 2010 Apr; cited 2014 Sep 27]. Available from: http://www.chcf.org~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20ConsumersHealthInfoTechnologyNationalSurvey.pdf
  • 60 Connolly MA, Gulanick M, Keough V, Holm K. Health practices of critical care nurses: Are these nurses good role models for patients?. Am J Crit Care 1997; 6 (04) 261-266.
  • 61 Rush KL, Kee CC, Rice M. The self as role model in health promotion scale: development and testing. West J Nurs Res 2010; 32 (06) 814-832. doi:10.1177/0193945910361595.
  • 62 The U. S. nursing workforce: Trends in supply and education [Internet]. U. S. Department of Health and Human Services. Health Resources and Services Administration Bureau of Health Professions National Center for Health Workforce Analysis; 2013 [updated 2013 Apr; cited 2014 Sep 27]. Available from: http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf
  • 63 Kim E, Mayani A, Modi S, Kim Y, Soh C. Evaluation of patient-centered electronic health record to overcome digital divide. Conf Proc IEEE Eng Med Biol Soc 2005; 2: 1091-1094.
  • 64 Just looking: consumer use of the internet to manage care [Internet].. Oakland: California Health Care Foundation; 2008 [updated 2008 May; cited 2014 Sep 27]. Available from: http://www.chcf.org/publications/2008/05/just-looking-consumer-use-of-the-internet-to-manage-care
  • 65 Topline results from a National Consumer Survey on Health IT [Internet].. Oakland: California Health Care Foundation; 2010 [updated 2010 Apr; cited 2014 Sep 27]. Available from: http://www.chcf.org~/media/MEDIA%20LIBRARY%20Files/PDF/T/PDF%20ToplineResultsNationalConsumerSurveyHIT.pdf
  • 66 Patel VN, Abramson E, Edwards AM, Cheung MA, Dhopeshwarkar RV, Kaushal R. Consumer attitudes toward personal health records in a beacon community. Am J Manag Care 2011; 17 (04) e104-e120.
  • 67 The nationwide privacy and security framework for electronic exchange of individually identifiable health information [Internet]. U. S. Department of Health & Human Services. Office of the National Coordinator for Health Information Technology; 2008 [updated 2008 Dec 15; cited 2014 Sep 27]. Available from: http://www.healthit.gov/sites/default/files/nationwide-ps-framework-5.pdf
  • 68 Nunnally JO. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978: 701 p.
  • 69 Waltz CF, Strickland OL, Lenz ER. Measumrent in nursing and health research. 4th ed. New York: Springer Publishing Company; 2010: 492 p.
  • 70 Pallant J. SPSS Survival Manual. 3rd ed. London: Open University Press; 2007: 335 p.
  • 71 Duyck P, Pynoo B, Devolder P, Voet T, Adang L, Vercruysse J. User acceptance of a picture archiving and communication system. Applying the unified theory of acceptance and use of technology in a radiological setting. Methods Inf Med 2008; 47 (02) 149-156.
  • 72 Yi MY, Jackson JD, Park JS, Probst JC. Understanding information technology acceptance by individual professionals: Toward an integrative view. Information & Management 2006; 43 (03) 350-363. doi:10.1016/j.im.2005.08.006.
  • 73 Day K, Gu Y. Influencing factors for adopting personal health record (PHR). Stud Health Technol Inform 2012; 178: 39-44.
  • 74 Silvestre AL, Sue VM, Allen JY. If you build it, will they come? The Kaiser Permanente model of online health care. Health Aff (Millwood) 2009; 28 (02) 334-344. doi:10.1377/hlthaff.28.2.334.
  • 75 Kannan SB. Safety net providers bring patients online: lessons from early adopters. Oakland: California Health Care Foundation.; 2009 [updated 2009 Apr; cited 2015 Jan 1]. Available from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/S/PDF%20SafetyNetPatientsOnline.pdf
  • 76 Schaper LK, Pervan GP. ICT and OTs: A model of information and communication technology acceptance and utilisation by occupational therapists. Int J Med Inform 2007; 76 (Suppl. 01) S212-S221. doi:10.1016/j.ijmedinf.2006.05.028.
  • 77 Tung FC, Chang SC, Chou CM. An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical industry. Int J Med Inform 2008; 77 (05) 324-335. doi:10.1016/j.ijmedinf.2007.06.006.
  • 78 Angst CM, Agarwal R. Adoption of electronic health records in the presence of privacy concerns: The elaboration likelihood model and individual persuasion. MIS Quarterly 2009; 33 (02) 339-370.
  • 79 Gagnon MP, Desmartis M, Labrecque M, Légaré F, Lamothe L, Fortin JP, Rancourt JF, Duplantie J. Implementation of an electronic medical record in family practice: A case study. Inform Prim Care 2010; 18 (01) 31-40.
  • 80 Strobl JF, Latter S. Qualified nurse smokers’ attitudes towards a hospital smoking ban and its influence on their smoking behavior. J Adv Nurs 1998; 27 (01) 179-188.
  • 81 Kelley K, Abraham C. Health promotion for people aged over 65 years in hospitals: Nurses’ perceptions about their role. J Clin Nurs 2007; 16 (03) 569-579.
  • 82 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: The importance of special people. Int J Med Inform 2003; 69 2–3 235-250.
  • 83 Courtney KL, Alexander GL, Demiris G. Information technology from novice to expert: Implementation implications. J Nurs Manag 2008; 16 (06) 692-699. doi:10.1111/j.1365–2834.2007.00829.x.
  • 84 Hsiao JL, Chang HC, Chen RF. A study of factors affecting acceptance of hospital information systems: A nursing perspective. J Nurs Res 2011; 19 (02) 150-160. doi:10.1097/JNR.0b013e31821cbb25.
  • 85 Karsh BT, Escoto KH, Beasley JW, Holden RJ. Toward a theoretical approach to medical error reporting system research and design. Appl Ergon 2006; 37 (03) 283-295. doi:10.1016/j.apergo.2005.07.003.
  • 86 ONC consumer campaign pledge. Silver Spring: American Nurses Association, Inc.; 2014 [cited 2014 Sep 27]. Available from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/ONC-Consumer-Campaign-Pledge.html?css=print
  • 87 Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). J Am Med Inform Assoc 2008; 15 (06) 729-736. doi:10.1197/jamia. M2547
  • 88 Fisher B, Bhavnani V, Winfield M. How patients use access to their full health records: a qualitative study of patients in general practice. J R Soc Med 2009; 102 (12) 539-544. doi:10.1258/jrsm.2009.090328.
  • 89 Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011 [Internet]. U. S. Department of Health and Human Services. NCHS data Brief, no 98, July 2012; 2012 [updated 2013 Jan 11; cited 2014 Sep 27]. Available from: http://www.cdc.gov/nchs/data/databriefs/db98.pdf
  • 90 Masys D, Baker D, Butros A, Cowles KE. Giving patients access to their medical records via the internet: The PCASSO experience. J Am Med Inform Assoc 2002; 9 (02) 181-191.
  • 91 Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: Toward a unified view. MIS Quarterly 2003; 27 (03) 425-478.
  • 92 Rothman KJ, Greenland S. Public health matters. Causation and causal inference in epidemiology. Am J Public Health 2005; 95: S144-S150.
  • 93 Venkatesh V, Davis FD. A theoretical extension of the technology acceptance model: Four longitudinal field studies. Management Science 2000; 46 (02) 186-204.