by Kay Sackett, DNS, RN
Sackett, K. (2014). Health Information Technology Research and Searching for the Perfect Technology Model. Online Journal of Nursing Informatics (OJNI), 18 (1), Available at http://ojni.org/issues/?p=3077
A very brief review of historical health information technology (HIT) research first focused on how particular technologies, like the EHR, were designed and implemented in healthcare organizations. The next phase of HIT research focused on EHR technology use by end-users within healthcare organizations. Today, increasing attention is being paid to consumer end-users who use EHR or Personal Medical Records (PMR) technology to manage their healthcare. Threaded throughout these three phases has been the development and adaptation of models to explain the changes technology adoption and use has played in society.
I’ve recently been doing a lot of reading on the topic of consumer engagement and healthcare portals. My goal with all of this reading is to immerse myself in the literature in preparation for writing a grant. Like any self-respecting academic, I have given myself the mission to search for the perfect technology-based model to enhance my health information technology related research. After weeks of searching and hours of reading, I’ve narrowed my choices down to three possible models: The Technology Acceptance Model-2 (TAM-2) collaboratively developed by Venkatesh and Davis (2003); the Health Information Technology Model (HITAM) co-developed by Kim and Park (2012); and, the Unified Theory of Acceptance and Use of Technology-2 (UTAUT-2) model co-developed by Venkatesh, Thong & Xu (2012). I am going to briefly describe what I’ve synthesized from each model to help clarify my thoughts on which model would be most appropriate to incorporate in my grant application.
The Technology Acceptance Model (Davis, 1989) is the pre-cursor to the TAM-2. The original TAM was developed to explain why workers within organizations were not using information technology. The basic idea was first to determine peoples’ perceived usefulness and ease of use, and determine their attitude and behavioral intention to use or accept technology. The TAM-2 further expanded this work to include the concepts of individuals’ subject norm, image, job relevance, output quality and demonstrate favorable results for technology use within organizations. Researchers in a variety of professions, including healthcare, have used the TAM and TAM-2 to demonstrate individuals’ technology use and acceptance within organizations. To the best of my knowledge, the TAM-2, without further modifications, has not been used with consumers.
The HITAM is another iteration of the TAM. It incorporates concepts from TAM-3, the Health Belief Model (HBM) and the theory of planned behavior (TPB) to determine consumers’ health behavioral intention as end-users of health information technologies. This model included antecedence from the TAM-3 including subjective norm, output quality, result demonstrability, computer self-efficacy, computer anxiety, computer playfulness, perceived enjoyment, objective usability and demographic variables. The mediating process included perceived usefulness, perceived ease of use, attitude and an outcome of behavioral intention and behavior. Antecedence from the HBM includes perceived susceptibility and perceived seriousness with a mediating process of perceived threat and an outcome of behavioral intention and behavior. The antecedence for TPB includes behavioral beliefs, normative beliefs and efficacy beliefs. The mediating process is subjective norm and attitude with an outcome of behavioral intention and behavior. To the best of my knowledge, the HITAM consumer-focused model has not been extensively used due to its relative newness.
The UTAUT-2 is yet another adaption of the original TAM. Building on the perceived usefulness and perceived ease of use concepts from TAM, the original UTAUT was developed and included the addition of individuals’ performance expectancy, effort expectancy, social influence and facilitating conditions were linked to determine behavioral intention to accept and actually use technology in organization. This model has also been used extensively within a multitude of organizations, including the healthcare arena. The UTAUT -2 was created to focus on consumers as end users of health information technology and included hedonistic motivation, price value and habit. Information related to age, gender and experience (individual differences) was also included. To the best of my knowledge, the UTAUT-2 consumer-focused model has not been extensively used due to its relative newness.
I’ve briefly described three technology adoption models that have potential relevance for inclusion in a grant I am writing. Each of the models’ has pros and cons for inclusion or exclusion in my grant. In the interest of collegiality, please email me at firstname.lastname@example.org with your thoughts about which model might best fit my research on consumer engagement with healthcare portals.
Davis, F. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13, p. 319-39.
eHealth Initiative. (2013). Results from survey on health data exchange 2013. The challenge to connect. Retrieved from http://www.EHIC.org
Green, R. (2013). EHR adoption can, should shed light on patient experience. Retrieved from http://www.egrintelligence.com/2013/08/19/her-adoption-can-should-shed-light-on-patient-experience
Hirsch, M. (2013). Workgroup: Stage 3 must ‘connect the dots’ between functionality, outcomes. FierceEMR. Retrieved from http://www.fierceemr.com/story/workgroup-stage-3-must-connect-dots-between-functionality-outcomes/2013-09-04
Holden, R. & Karsh, B-T. (2010). The technology acceptance model: Its past and its future in health care. J Biomed Inform, 43(1): 159, p. 1-30. doi: 10.1016/j.jbi.2009.07.002.
Judd, D. & Sackett, K. Electronic Health Record (EHR) meaningful use (MU) essentials for perceived nursing benefit, ease of use, acceptance, and satisfaction experienced by Registered Nurses (RNs) and Nurse Practitioners (NPs): An Integrative Review. Unpublished Manuscript.
Kim, J. & Park, H-A. (2012). Development of a health information technology acceptance model using consumers’ health behavior intention. Journal of Medical Internet Research (JMIR), 14(5), e133. doi: 10.2196/jmir.2143.
Murphy, K. (2014). How does patient engagement transform into useful EHR data? Retrieved from http://www.ehrintelligence.com/2014/01/14/how-does-patient-engagementransform-into-useful-her-data/
Nazi, K. (2013). The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health records systems in organizational and clinical settings. Journal of Medical Internet Research (JMIR), 15 (4), e70, p. 1-37. doi: 10.2196/jmir.2443.
Venkatesh, V. & Davis F. (2000). A theoretical extension of the technology field studies. Management Science, 46, p. 186-204.
Venkatesh, V., Morris, M., Davis, G. & Davis, F. User acceptance of information technology: Toward a unified view. MIS Quarterly, 27, p. 425-78.
Venkatesh, V., Thong, J. & Xu, X. (2012). Consumer acceptance and use of information technology: Extending the unified theory of acceptance and use of technology. MIS Quarterly, 36(1) p. 157-178.
Technology acceptance model. Retrieved from http://en.wikipedia.org/wiki/Technology_acceptance_model#CITEREFVenkateshDavis2000