Factors affecting the adoption and use of Electronic Patient Record (EPR) systems in cancer treatment services

Background: Healthcare services around the world have developed computerised information systems to gradually replace traditional paper-based medical records. In oncology services, a diverse range of multi-organisational patient record systems are currently undergoing continuous development and improvement. Achieving technology acceptance in clinical environments is a complex aspect of the development and implementation of socio-technical systems. Whilst there has been previous research conducted about technology acceptance in oncology, gaps and limitations remain unexplored, particularly in relation to the full range of EPR system functionality. From a clinical end users’ perspective, this research aimed to discover the factors that influence clinicians’ attitudes towards and their use of oncology EPR systems. Methodology: This mixed methods research comprised two studies. In the first exploratory study, a patient records survey questionnaire was conducted to gather information about participants’ use of patient records and clinical information systems at a large regional cancer hospital. The findings and themes that emerged from the first study were used in conjunction with a social-technical systems theoretical framework to design and structure the second study. In the second study, in-depth qualitative interviews were conducted with oncologists to further investigate their views and identify key factors that affect their adoption and use of EPR systems. Phenomenography was used as the main qualitative approach for analysing the interview transcripts, and the researcher identified categories of description and the “outcome space” that explains the different ways that oncologists think about EPR systems. Following triangulation of the results, the findings were developed into recommendations for further research and practical guidance for health informatics practitioners in the form of a conceptual reference model, CICERO (Comprehensive, Integrated, Customised Electronic Records for Oncology). Findings: The exploratory study found that while the majority of respondents found the existing EPR systems easy to use, a range of factors affected the full adoption and use of these systems. Medical staff, in particular, reported problems with accessibility, integration, and usability. The qualitative study found that the alignment of technology, tasks, and individuals could be improved with increased emphasis on understanding the fit between oncologists and the clinical tasks they perform. Phenomenographical analyses produced an outcome space that included three categories of description related to the qualitatively different ways in which oncologists think about EPR systems. In the first category, oncologists thought of EPR systems as a simple legal record of a patient’s care and treatment; in the second category, where most oncologists were positioned, they viewed EPR systems as a means of providing information to aid memory and communication; and in the third category, oncologists thought of EPR systems as advanced tools for clinical workflow, decision support, and interoperability. Conclusion: Various socio-technical factors should be considered when designing, developing, and implementing EPR systems in oncology, with a view to maximising technology acceptance by clinical end users. In line with prior studies, the key factors identified were accessibility, integration, and usability. Additional factors included clinical staff participation in system design and development activities. In summary, oncologists are more likely to perceive EPR systems in the third category of description and adopt them if they can see specific benefits being gained from their use. Keywords: Oncology, information systems, electronic patient records, technology acceptance, cancer services, socio-technical systems