Barriers to electronic health records deployment in Armenia: A cross-sectional study

Abstract

Background: Currently health care systems face significant challenges related to the need to harness an ever increasing flow of information, which, if done correctly, can bring to many benefits including improved quality of care, efficiency and cost containment. Information technology (IT) provides powerful tools for optimizing health information management and modernizing the whole health care system. Electronic health record (EHR) is a crucial tool for that purpose. The literature review revealed that implementing EHR in a health care system is related to many different barriers at individual and organizational levels including individual characteristics, personal attitudes and negative perceptions of potential users, effort expectancy related to the usage, resistance to change, clinical concerns, financial, technical and structural barriers, lack of trust and facilitating conditions. Objective: The main objective of this study is to understand major barriers to successful implementation and widespread adoption of EHR system from the perspective of physicians in Armenia. Methods: The study is a cross-sectional survey of physicians working in hospitals of Yerevan and selected through multi-stage cluster sampling. The research team developed the survey instrument based on literature review and existing instruments. Results are analyzed in exploratory structural equation modeling (ESEM) framework using the Robust weighted least squares (WLSMV) estimator for categorical indicators. Analysis is done in two steps: first - evaluation and modification of measurement model; second - testing of structural model. Results: Several factors have direct effects on Intention to use EHR including Projected group usefulness, Personal innovativeness, interference with patient-provider relationships and Resistance to change. Other effects are mediated through Projected group usefulness, Perceived usefulness and Perceived ease of use. Particularly, Innovativeness, Patient-provider relationships, Organizational support and Computer anxiety predicts Perceived ease of use. Ease of use with Resistance, Administrative monitoring and Professional relationships predict Perceived usefulness. Perceived usefulness with Professional relationships and Organizational change predict Projected group usefulness, which transmits all these effects to final outcome – Intention to use. Older age is associated with a decrease in Perceived usefulness and Projected group usefulness, while being female is associated with higher Projected group usefulness. Medical specialty also has significant effects. Conclusion: Findings suggest that major barriers to EHR implementation in Armenia are clinical concerns at group level (Projected group usefulness), personal attitudes (Perceived usefulness), effort expectancy (Perceived ease of use), Resistance to change, personal characteristics such as Innovativeness and Computer anxiety, and negative perceptions such as interference with Patient-provider and Professional relationships. Organizational support, anticipated Administrative monitoring and Organizational change poses facilitating effects. The study team made the following recommendations to overcome the identified barriers: incorporate organizational reforms as part of EHR implementation in Armenia, demonstrate the utility of EHR at organizational level, provide trainings for users, identify and enroll local EHR champions in the implementation process.