Seminar

Abstract

Since World Health Assembly encouraged countries to create their own eHealth plans in 2005, there has been an increasing interest in using information technology (IT) for educating medical staff, conducting research, treating patients, monitoring public health and tracking several types of diseases [1]. Electronic health record (eHR), one of the components of eHealth is expected to reduce cost, eradicate medical waste, increase accessibility of medical records and improve quality of healthcare outcomes [2]. Some developed countries such as United States, United Kingdom, Canada, Germany, Australia, Netherland and New Zealand have successfully implemented a great level of ambulatory eHR; however, lack of efforts and strategies were found with respect to Health Information Exchange (HIE) and impatient eHR [2]. HIE is growing opportunity to let medical staff access comprehensive medical records of their patients before making appropriate medical decisions about them. It also helps timely access to a patient records that required for medical team to improve patient safety and reduce cost of care. 

There are several incentives taken to enhance HIE. One of the most current and exciting attempt involves a great incentive via setting public private partnership and implementing county wide electronic health records available for both public and private health organizations. The idea of exchanging medical records brought several opportunities to reduce repeating of medical tests and improve patient safety when patients shift between public and private medical organizations. An example of HIE in this study provides a top-down approach where Hong Kong Government has actively taken incentives to centrally store and share electronic health records for healthcare purposes using the Electronic Health Record Sharing System (the eHRSS) in public and private sectors [3]. The eHRSS was launched in March 2016 with the aim of public and private sectors to access and share patients' eHR for healthcare purposes. As at early March 2019, over 1 million patients have registered with the system as the system marks its 3rd year anniversary. In addition to that, over 1,700 Healthcare Providers (HCPs) from private sector (e.g. private clinics, welfare organizations, elderly homes) had joined the system where they had created 47,000 user accounts to facilitate provision of healthcare services at their institutions. Role-based access to the eHRSS enabled to healthcare staff working at the Hospital Authority (HA), the Department of Health (DH) and all of the 12 local private hospitals. In early stage of the eHR, access to the eHRSS has only abled for doctors. Later on, HCPs such as doctors, dentists, nurses and midwives already got access to the system. The access rights for the other six types of Healthcare professional (HCProfs) are expected to be launched in third quarter of 2019.  These six HCProfs would be following professions such as: pharmacists, medical laboratory technologists, occupational therapists, optometrists, radiographers and physiotherapists. Current sharable scope between public and private healthcare organizations is in 5 categories which are diagnosis, laboratory records, appointment, allergy & adverse reaction, prescribing history. Stage II Development of the eHRSS is now underway and it involves expansion of the sharable scope (Chinese medicine information and radiological images), development of a "Patient Portal" and continuous enhancement of the system's security and privacy protection.

Users’ reactions for IT have been assessed in different industries other than healthcare. The Unified Theory of Acceptance and Use of Technology (UTAUT) is most current model for assessing IT acceptance and adoption after launching of Technology Acceptance Model (TAM) in 1980s. Unlikely to other industries, users’ reactions to such eHR technologies haven’t been assessed and evaluated appropriately. Although the existing literature has focused on design and implementation of those eHR technologies [4-7], little attention was paid to how healthcare staff find those available technologies useful or easy to use. The fit between healthcare staff and proposed IT is depend on users to accept, reject, use and misuse of a technology. If healthcare staff find proposed IT useful or easy to use, then an eHR would provide a great chance to improve quality and safety in healthcare such as reducing errors (medical incidents), saving resources (less repeated test), providing secure and timely access to comprehensive patient records for both public and private providers [8]. This study aims to identify significant constructs that display key roles in the eHR acceptance and adoption at both public and private healthcare institutions. It will also provide feedback driven from using the eHR among physicians, nurses and healthcare assistants. For further development and enhancement of the eHR, this study will highlight perceived strengths and weaknesses of the eHR that used through access to the EHRSS or the Clinical Management System (CMS, include sub-systems of CMS) in Hong KongSAR. Moreover, the study will analyse why private clinics are not joining to the eHR for the purpose of information exchange.