Electronic Health Record Portal Adoption: A cross country analysis

Abstract

Background: This study's goal is to understand the factors that drive individuals to adopt Electronic Health Record (EHR) portals and to estimate if there are differences between countries with different healthcare models. Methods: We applied a new adoption model using as a starting point the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) by incorporating the Concern for Information Privacy (CFIP) framework. To evaluate the research model we used the partial least squares (PLS) - structural equation modelling (SEM) approach. An online questionnaire was administrated in the United States (US) and Europe (Portugal). We collected 597 valid responses. Results: The statistically significant factors of behavioural intention are performance expectancy (β ^ \widehat{\beta} total = 0.285; P < 0.01), effort expectancy (β ^ \widehat{\beta} total = 0.160; P < 0.01), social influence (βtotal = 0.198; P < 0.01), hedonic motivation (β ^ \widehat{\beta} total = -0.141; P < 0.01), price value (β ^ \widehat{\beta} total = 0.152; P < 0.01), and habit (β ^ \widehat{\beta} total = 0.255; P < 0.01). The predictors of use behaviour are habit (β ^ \widehat{\beta} total = 0.145; P < 0.01), and behavioural intention (β ^ \widehat{\beta} total = 0.480; P < 0.01). Social influence, hedonic motivation, and price value are only predictors in the US group. The model explained 53% of the variance in behavioural intention and 36% of the variance in use behaviour. Conclusions: Our study identified critical factors for the adoption of EHR portals and significant differences between the countries. Confidentiality issues do not seem to influence acceptance. The EHR portals usage patterns are significantly higher in US compared to Portugal.