International Journal of Medical Informatics RSS feed: Current Issue. The Journal provides an international medium for dissemination of original results and interpretative reviews concerning the field of medical informatics. The Journal emphasizes the evaluation of systems in healthcare settings. The scope of the journal covers: • Information systems, including national or international registration systems, hospital information systems, departmental and/or physician's office systems, document handling systems, electronic medical record systems, standardization, systems integration etc.; • Computer-aided medical decision support systems using heuristic, algorithmic and/or statistical methods as exemplified in decision theory, protocol development, artificial intelligence, etc. • Educational computer based programs pertaining to medical informatics or medicine in general. • Organizational, economic, social, clinical impact, ethical and cost-benefit aspects of IT applications in health care. Short technical communications concerning (solved) problems in implementing or using existing information systems are welcome. Review articles concerning subjects falling in the scope of the journal are also invited. http://www.ijmijournal.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. International Journal of Medical Informatics1386-5056812February 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ijmijournal.com/article/PIIS1386505612000068/abstract?rss=yesEditorial Board10.1016/S1386-5056(12)00006-8International Journal of Medical Informatics 81, 2 (2012)2012-02-01International Journal of Medical Informatics2012-02-01812S1386-5056(12)X0002-9iihttp://www.ijmijournal.com/article/PIIS1386505611002358/abstract?rss=yesHighlights: ► Longitudinal analysis of CIS adoption in two Quebec Family Medicine Groups. ► Seven distinct user profiles were drawn from the dynamics of CIS implementation. ► Users’ perceived barriers and drivers corresponded with their profile assignment. ► This study provides insight into the tailoring of CIS implementation strategies.Abstract: Given the increasing prevalence of multimorbidity in primary care (PC), interdisciplinary PC teams supported by appropriate clinical information systems (CIS) are needed in order to deal with the complexity of multimorbid patients’ care. Our team has developed such a system, called the Da Vinci system. However, despite the expected benefits, evidence suggests generally low rates of CIS adoption. To optimize adoption in PC settings, a better understanding of the implementation process of such systems is crucial.Purpose: To identify user profiles, investigate the drivers of and barriers to adoption and use of the Da Vinci system, a PC tailored CIS, and understand the dynamics of the CIS adoption for each profile.Methods: Using a longitudinal approach, we conducted a qualitative study (individual interviews, documentation and observation) based on the Diffusion of Innovation theory. It included 31 participants (primary care physicians, staff or residents, nurses, pharmacists) from two Family Medicine Groups in Quebec (Canada).Results: The different user profiles drawn from the dynamics of implementation are linked to different sets of perceived drivers and barriers that evolve over time. Certain factors favour the decision of adopting Da Vinci early on: e.g. user skills and the system's expected ease of use and usefulness. Certain concerns hinder its adoption: e.g. perceived negative impact on the doctor–patient relationship.Over time, 5 factors appear to be related to more advanced exploitation of the system's functionalities: user skills, ease of use, comfort using the system in front of patients, support from colleagues and, more importantly, perceived positive impacts.Conclusions: A better understanding of the dynamics of CIS implementation provides insight into how best to encourage clinicians to adopt and make full use of such systems to improve the quality of care for multimorbid patients followed in PC settings.Healthcare professionals’ adoption and use of a clinical information system (CIS) in primary care: Insights from the Da Vinci studyIsabelle Vedel, Liette Lapointe, Marie-Thérèse Lussier, Claude Richard, Johanne Goudreau, Lyne Lalonde, Alain Turcotte10.1016/j.ijmedinf.2011.11.002International Journal of Medical Informatics 81, 2 (2012)2011-12-22International Journal of Medical Informatics2011-12-22812S1386-5056(12)X0002-97387http://www.ijmijournal.com/article/PIIS1386505611002176/abstract?rss=yesHighlights: ► PACS’ ease of use is the main driver for physicians to start using PACS. ► The drivers for PACS acceptance vary over time. ► Support by peers and hospital management is very important for PACS-acceptance. ► Focus training first on basic tasks; introduce advanced functionalities gradually. ► Multiple measurements uncover dynamics underlying the acceptance process.Abstract: Purpose: The purpose of this study is to gain a better insight into the reasons why hospital physicians accept and use a Picture Archiving and Communication System (PACS). Two research questions are put forward, pertaining to (1) factors that contribute to physicians’ acceptance of PACS, and (2) whether these factors change as physicians gain experience in using PACS.Methods: Questionnaires were administered at three moments in time during the PACS implementation process in a private hospital: just before its introduction (T1), four months later (T2), and about fifteen months after the introduction of PACS (T3). The Unified Theory of Acceptance and Use of Technology was chosen as the theoretical framework for this study. Hence, the following scales were measured: performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, and self-reported frequency of use.Results: Forty-six usable responses were obtained at T1, 52 at T2 and 61 at T3. Three variables directly influenced PACS acceptance (measured as behavioral intention and use of PACS): effort expectancy, performance expectancy, and social influence; and their influence evolved over time. Effort expectancy was of particular importance at T1, whereas performance expectancy influenced acceptance at T2 and T3; social influence was the only consistent predictor of PACS acceptance at all times. Variance explained in behavioral intention ranged from .26 at T1 to .58 at T3.Conclusions: In this setting, the main motivation for physicians to start using PACS is effort expectancy, whereas performance expectancy only becomes important after the physicians started using PACS. It is also very important that physicians perceive that their social environment encourages the use of PACS.Do hospital physicians’ attitudes change during PACS implementation? A cross-sectional acceptance studyBram Pynoo, Pieter Devolder, Wouter Duyck, Johan van Braak, Bart Sijnave, Philippe Duyck10.1016/j.ijmedinf.2011.10.007International Journal of Medical Informatics 81, 2 (2012)2011-11-09International Journal of Medical Informatics2011-11-09812S1386-5056(12)X0002-98897http://www.ijmijournal.com/article/PIIS138650561100178X/abstract?rss=yesHighlights: ► Physicians’ experiences of participatory IT development are negative. ► Physicians are willing to participate in healthcare IT systems development. ► Better methods for end-user participation are needed.Abstract: Objective: To learn (1) about the kind of experiences that physicians have with participation in healthcare IT development; (2) whether physicians are interested in participating in IT development activities, and if so, how; and (3) the visions that physicians have regarding future IT systems.Methods: A web-based questionnaire which was answered by about one-third of the working-age physicians in Finland, which is exceptionally broad and sizeable a sample. This research deals with only a small part of the entire questionnaire. The questions used for this study were both quantitative and qualitative. Statistical methods were applied to the former and content analysis to the latter.Results: The responding physicians were highly critical of their IT systems, and their experiences with the current methods of participation, or rather the lack of it, were quite negative. However, a very significant proportion of the respondents were willing to contribute to IT systems development, contrary to a common assumption that clinicians are disinterested. Visioning of future systems was quite cautious, dealing mainly with usability improvements to the current systems.Conclusions: Major improvements are needed both in the usability of the systems currently in use in Finland and in the collaboration between end-users and developers. Improved methods of participation need to be developed and applied, particularly for the procurement, deployment and on-going development of commercial-off-the-shelf applications.Physicians’ experiences of participation in healthcare IT development in Finland: Willing but not ableSusanna Martikainen, Johanna Viitanen, Mikko Korpela, Tinja Lääveri10.1016/j.ijmedinf.2011.08.014International Journal of Medical Informatics 81, 2 (2012)2011-09-28International Journal of Medical Informatics2011-09-28812S1386-5056(12)X0002-998113http://www.ijmijournal.com/article/PIIS1386505611002218/abstract?rss=yesHighlights: ► The purpose of the study was to understand the preparations for the introduction of EPRs within the outpatient services department of a large UK hospital. ► The study examined the likely impact of the EPRs on working practices within the department. ► Interviews were conducted with 27 staff members within the department. ► Results show positive support for new EPRs, alongside high levels of scepticism towards previous attempts to introduce national systems (i.e., the UK NPfIT). ► The feasibility of a ‘paperless hospital’ was seen as unlikely by departmental staff.Abstract: Purpose: The purpose of the study was to understand the preparations for the introduction of electronic patient record systems (EPRs) within the outpatient services department of a large acute hospital based in the UK. In particular, one of the main aims of the study was to examine in detail the likely impact of EPRs on the working practices of healthcare workers, their expectations regarding the impact of EPRs within the department and other sociotechnical aspects of the management of patient information.Methods: Twenty-seven semi-structured interviews were undertaken with staff in a variety of roles that deal with the management of medical records. The interviews focused on the organisation of the medical records department and current problems (e.g., missing records). In addition, the interviews contained questions about the specific role of medical records supervisors in the administration of records, as well as pathways and expectations about EPRs more generally. The data from the interviews was analysed using a mixture of thematic and template analysis and coded using constructs from a sociotechnical model of information system implementation and adoption.Results: The findings show that despite severe delays to the nationally led (NPfIT) roll-out of EPRs and associated IT infrastructure within the UK, staff attitudes within the department were broadly positive about the potential of future EPRs to deliver efficiencies (e.g., improved workflow within the department, reduced reliance on paper-based systems). One of the main influences on attitudes towards the type of EPRs that should exist within outpatients was prompted by negative reactions to the way in which NPfIT systems had been managed and attempted to be introduced in the past. A strong commitment to end-user involvement in EPRs design, together with a rejection of NPfIT, appears to have shaped attitudes towards future expectations of the adoption of new EPRs within the department. In addition, staff do not believe that a rapid change to ‘paperless’ working is likely to be possible.Conclusions: Our findings provide further evidence that there is a need to treat the implementation of EPRs not simply as an exercise in technical system delivery, but as a larger process of sociotechnical systems change. We conclude the paper with some guidelines, the aim of which is to provide guidance regarding EPRs implementation and adoption informed by sociotechnical principles and ideas.Preparing the ground for the ‘paperless hospital’: A case study of medical records management in a UK outpatient services departmentPatrick Waterson, Yolande Glenn, Ken Eason10.1016/j.ijmedinf.2011.10.011International Journal of Medical Informatics 81, 2 (2012)2011-11-16International Journal of Medical Informatics2011-11-16812S1386-5056(12)X0002-9114129http://www.ijmijournal.com/article/PIIS1386505611002012/abstract?rss=yesHighlights: ► An empirical study was conducted to understand physicians’ acceptance of the Medline. ► The decomposed TPB provides a powerful explanation of the physicians’ usage intentions toward Medline. ► A physician's usage intention is significantly influenced by attitude, the SN, and PBC. ► Resource facilitating conditions have no significant influence on PBC.Abstract: Purpose: Evidence-based medicine (EBM) supports physicians in their improvement of clinical quality and enhances hospitals’ improvement of patient safety. Many health care institutions implement information systems to support physicians practicing EBM. However, studies exploring the antecedent factors of physicians’ usage intention of information systems facilitating EBM practice are rare. Hence this study proposed a research model based on the decomposed theory of the planned behavior model (decomposed TPB) to investigate the factors influencing physicians’ acceptance of the Medline system.Methods: A field survey was conducted in Taiwan to collect data from physicians with experience in using the Medline system. A valid sample of 224 physicians was collected for data analysis. Structural equation modeling using the partial least squares (PLS) method with bootstrap estimate was used to test the research model.Results: The findings of this study show that a physician's usage intention is significantly influenced by three factors, i.e. attitude, the subjective norm, and perceived behavior control. Furthermore, these three factors can be predicted by perceived usefulness and perceived ease of use, interpersonal influence, personal innovativeness in IT and self-efficacy, respectively.Conclusions: The results of this study indicate that our research model provides an effective prediction of the intention of physicians to use the Medline system and provides valuable implications for academics and practitioners.Understanding physicians’ acceptance of the Medline system for practicing evidence-based medicine: A decomposed TPB modelShin-Yuan Hung, Yi-Cheng Ku, Jui-Chi Chien10.1016/j.ijmedinf.2011.09.009International Journal of Medical Informatics 81, 2 (2012)2011-11-02International Journal of Medical Informatics2011-11-02812S1386-5056(12)X0002-9130142