A STUDY OF INNOVATION DIFFUSION OF ELECTRONIC

PATIENT RECORDS FOR SUPPORTING MEDICAL PRACTICE

Vincent Cho and Geoffrey Lieu

Department of Management and Marketing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

Keywords: Innovation diffusion, electronic patient record.

Abstract: This paper proposes a study on the underlying factors affecting the adoption, routinization and infusion of

electronic patient record in the clinics of Hong Kong. We suggest using a focus group to identify the

potential antecedents for the three stages of innovation diffusion (adoption, routinization and infusion).

Then a theoretical framework based on the antecedents and their impact on innovation diffusion will be

layout. It will be verified upon a survey sending to the medical practitioners in Hong Kong.

1 INTRODUCTION

We are well into the digital information age. Digital

communications and information resources affect

almost every aspect of our lives – business, finance,

education, government and entertainment. Clinical

practice is highly information intensive, but it is one

of the few areas of our society where computer

access to information has had only limited success.

Most IT practices in health care by physicians

have been applied to office management in areas

related to accounting of the business, and the

scheduling on patients’ booking. The adoption of

Electronic Patient Records (EPRs) - medical

computerized systems that organize the information

on a patient’s treatment, diagnosis and results from

laboratory and other testing – appears limited. The

possibility of instant, universal access to up-to-the-

minute, accurate patient information is a goal that is

actively sought throughout health services

organizations. It is increasingly recognized that

EPRs bring along the quality benefits of electronic

documentation and viewing, prescription and test

ordering, care management reminders, and

messaging, among other medical systems. Thus,

EPRs are important tools for improving patient

safety and quality of care, especially by promoting

the practice of evidence-based medicine.

Despite this potential for quality improvement,

however, few physician practices use EPRs.

Nevertheless, interest in EPRs is substantial. A

recent survey in 2005 indicated that among 1061

respondents to a random sampling of members of

the Medical Group Management Association in US,

one in five said they were using an EPR and 40

percent of those without one told they plan to

acquire the technology within the next two year.

Clearly, the EPR is of growing importance for many

physician practices.

In face of adoption barriers, there has been much

research outlining the healthcare system’s move

towards EPRs for example (Ross and Lin, 2003;

Tachinardi et al. 2001; Van’t Riet et al., 2001).

However, most of these studies are US based. This

study attempts to investigate the facilitating and

inhibiting factors that affect health care practitioners

to adopt EPRs in Hong Kong; to understand the

health care practitioners on their attitude and

knowledge towards EPRs in health care practice and

to explore the existing utilization and future

intention on EPRs in private sector of the health care

industry.

2 THEORETICAL FRAMEWORK

To predict acceptance of technology, a number of

intention-based theories have evolved, i.e. the theory

of planned behavior (Ajzen, 1991), theory of

reasoned action (Fishbein and Ajzen, 1975) and the

technology acceptance model (Davis, 1989; Davis et

al. 1989). According to these theories, user beliefs

and attitudes about IT influence adoption and usage

behaviours. With few exceptions, however, most

studies using these theories have ignored the

temporal dimension and the antecedent variables

421

Cho V. and Lieu G. (2008).

A STUDY OF INNOVATION DIFFUSION OF ELECTRONIC PATIENT RECORDS FOR SUPPORTING MEDICAL PRACTICE.

In Proceedings of the International Conference on e-Business, pages 421-424

DOI: 10.5220/0001904704210424

 SciTePress

that may affect beliefs and attitudes at different

stages of the adoption process. Those that have,

stress its importance and the need for further study.

For example, Venkatesh and Davis (2000) report

that the same variables had different effects at

different stages of the adoption process, and

Fichman and Kemerer (1999) emphasize the need to

capture the time of deployment instead of, or in

addition to, time of acquisition as the bases for

diffusion modeling, driven the observed pattern of

cumulative adoptions varies depending on which

event in the assimilation process (i.e. acquisition or

deployment) is treated as the adoption event.

Further, Agarwal and Prasad (1997) support this

view that intention-based models may not explain

user adoption behavior at the different stages of the

adoption process.

Based on this evidence, the current study

considers the Rogers’ (1995) stage-based diffusion

of innovation model to be the most appropriate to

guide its investigation of the formation and change

over time of user attitudes and subsequent

acquisition and deployment decisions.

Everett Rogers defines diffusion as “the process

by which an innovation is communicated through

certain channels over time among the members of a

social system” (Rogers, 1983, p.5) where innovation

has been described as an idea, material, or artifact

perceived to be new by the relevant unit of adoption

(Zaltman, Duncan, and Holbek, 1973). There are

two types of communication channels have been

influential in diffusing technology – mass media

channels and interpersonal channels. Mass media are

radio, television, newspapers, and so on, which

enable a source of one or a few individuals to reach

an audience of many. And interpersonal channels are

face to face, telephone, and personal networks. In his

review of innovation diffusion, Rogers (1995)

reported mass media channels were most influential

in introducing potential adopters to an innovation,

whereas interpersonal channels were more

influential in subsequent stages.

Innovation diffusion research postulates that

many different outcomes are of interest in

technology adoption, including the initial adoption,

the subsequent routinization and infusion of the

innovation. This view is consistent with the stage

model as proposed and empirically validated by

Cooper and Zmud (1990). These stages of

implementation (as shown below) are not

necessarily sequential, and should be considered

activities that may occur in parallel (Cooper &

Zmud 1990):

• Initiation – Analyzing organizational needs

and potential IT solutions

• Adoption – Negotiating to get

organizational backing for IT

implementation

• Adaptation – Developing, installing and

maintaining the IT application,

revising/developing organizational

procedures, training of end-users

• Acceptance – Inducing the organizational

members to use the technology

• Routinization – Encouraging the use of the

IT application as a normal activity

• Infusion – Effective use of the technology

results in the intended benefits (increased

organizational effectiveness) of the IT

being obtained.

Initiation, adoption and adaptation require both

managerial and end-user input and buy-in, and the

remaining three stages require necessary dialogues

between organizational members for progression

through each stage to occur. Additionally, it is

widely recognized that successful implementation

depends upon gaining organizational members’,

targeted as end-users of the innovation, appropriate

and committed use of an innovation (Leonard-

Barton and Deschamps 1988; Klein and Sorra 1996).

It is through the development of a critical mass of

individual routinization and infusion that eventual

organizational infusion of an innovation is achieved

(Tornatzky and Fleischer 1990; Klein and Sorra

1996), and organizational benefits might then be

obtained.

Based on the situation in Hong Kong’s clinical

practices, most private clinics are either solo

practices or partnerships of a few medical doctors

that are small in size. Thus the respective process on

EPR initiation, adaptation and acceptance are rather

straight forward. In this regard, we would like to

focus our study on the other three different stages:

adoption, routinization and infusion on EPRs in

supporting medical practice.

The measure on adoption is based on whether

the organization has implemented any EPR.

Routinization is measured by the usage of the EPR

according to the daily tasks of a clinic. Infusion is

measured by the extent of the EPR being integrated

with other internal systems within the clinic or

external systems outside the clinic. Moreover, the

antecedents on these three essential stages will be

identified.

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3 DATA COLLECTION

A trivial approach to study different stages of a

clinic would be longitudinal tracing, but this takes

years on the data collection. Nevertheless, we

assume different clinics have different extents on the

diffusion stages. Some earlier adopters would be

more focused on infusion at current moment while

some late adopters are still struggling with the

routinization of the EPR practice. Thus a cross

sectional approach would be adequate for

understanding on the diffusion situation of EPRs in

Hong Kong. Moreover, we suppose most clinics are

not purely on a single stage of the EPR diffusion,

they would be 70% adopting on the EPR, with 50%

routnizing the EPR practice and 5% infusing the

EPR with their daily tasks. In this regard, cross-

sectional approach would make more sense to have

the overall picture.

Data for this study will be firstly gathered in a

focus group interview from which the possible

antecedents and measurements on adoption,

routinization, and infusion will be determined. A

structured questionnaire will be constructed based

on the literature with amendments from the focus

group to fit the Hong Kong medical practice. The

questionnaire will be pilot tested, revised if

necessary, and then sent extensively by mail to

private sector doctors. From the survey, the

respondent (the principle doctor who hosts the

clinic) will be asked about the current usage on EPR

which consists of the three dimensions on the extent

of adoption, routinization, and infusion. The

respondent will then evaluate the importance of

some pre-defined antecedents on the three respective

dimensions of usage. Some open-ended questions

will be supplemented any other antecedents not to be

included.

The Hong Kong Medical Association (HKMA)

has available to the public on the Internet a directory

of its members by clinical specialty and geographic

location. This list includes essentially all registered

private practice doctors in Hong Kong, estimated at

about 4,000 in total.

As the data collection instrument will be a

mailed questionnaire, we will randomly sample

2,000 doctors listed in the HKMA directory. For the

replied respondent, we will mail a $50 Park’N shop

couple (for the first 400 respondents) and a summary

of our finding as a reward.

4 METHODOLOGY

We shall obtain the means, standard deviations, and

bivariate correlations for all data used to analyze

predictions of all variables. We intend to perform a

factor analysis on the reasons for adopting new

technologies as well as those for not adopting these

technologies. A multiple ordinary least squares

(OLS) regression analysis will be the primary

statistical technique to be employed in our study. We

shall control for complementarities in the variables

and also check whether control variables will have

any significant influence on the data.

5 CONCLUSIONS

With our results on the survey, we will understand

the facilitating and inhibiting factors as well as the

existing practice of EPRs in Hong Kong private

clinic. This study will establish a theoretical

examination on the diffusion model and inject the

managerial insight on how to utilize the EPRs to a

greater extent.

ACKNOWLEDGEMENTS

This research was supported in part by The Hong

Kong Polytechnic University under grant number A-

PA7X.

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