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Electronic medical record systems: decision support examination framework for individual, security and privacy concerns using multi-perspective analysis

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Abstract

Electronic medical record (EMR) is currently a popular topic in e-health. EMR includes the health-related information of patients and forms the main factor of e-health applications. Moreover, EMR contains the legal records that are created in the medical centre and ambulatory environments. These records serve as the data source for electronic health record. Although hospitals utilise the EMR system, healthcare professionals experience difficultly in trusting this system. Studies devoted to EMR acceptance in hospitals are lacking, particularly those on the EMR system in the contexts of privacy and security concerns based on multi-criteria perspective. Thus, the current study proposes a decision support examination framework on how individual, security and privacy determinants influence the acceptance and use of EMR. The proposed framework is based on a multi-criteria perspective derived from healthcare professionals in Malaysia as frame of reference. The framework comprises four phases. The sub-factors of individual, security and privacy determinants were investigated in the two initial phases. Thereafter, the sub-factors were identified with uniform multi-criteria perspective to establish a decision matrix. The decision matrix used individual uniform as basis to cluster the sub-factors and user perspectives. Subsequently, a new ‘multi-criteria decision-making (MCDM) approach’ was adopted. Integrated technique for order of preference by similarity (TOPSIS) and analytic hierarchy process (AHP) were used as bases in employing the MCDM approach to rank each group of factors. K-means clustering was also applied to identify the critical factors in each group. Healthcare professionals in Malaysia were selected as respondents and 100 questionnaires were distributed to those employed in 5 Malaysian public hospitals. A conceptual model adapted from Unified theory of acceptance and use of technology 2 (UTAUT2) was employed to clarify the connection between individual, privacy and security determinants and EMR system acceptance and use in the selected context. After collecting the data sets (363), structural equation modelling was used to analyse data related to EMR acceptance and use. Results are as follows. (1) Five determinants (i.e. data integrity, confidentiality, non-repudiation, facilitating conditions and effort expectancy) exerted an explicit and important positive effect on EMR acceptance and use. (2) Three determinants (i.e. unauthorised, error and secondary use) exerted a direct and significant negative effect on EMR acceptance and use. (3) Three other determinants (i.e. authentication, performance expectancy and habit) insignificantly affected the behavioural intention of healthcare experts in Malaysia to use EMR.

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Authors and Affiliations

  1. Faculty of business, Meddle east university (MEU), Amman, Jordan

    Odai Enaizan

  2. Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia

    A. A. Zaidan, B. B. Zaidan, M. A. Alsalem, O. S. Albahri & A. S. Albahri

  3. Faculty of Science and Technology, University Sains Islam Malaysia, Nilai, Malaysia

    N. H. M Alwi

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  1. Odai Enaizan
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  2. A. A. Zaidan
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  3. N. H. M Alwi
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  4. B. B. Zaidan
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  5. M. A. Alsalem
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  6. O. S. Albahri
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  7. A. S. Albahri
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Correspondence to A. A. Zaidan.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants of the study.

Additional information

Highlights

• Identify the privacy, security, and individual factors that could effect on acceptance and use of an EMR system in Malaysian public hospitals.

• Established a decision matrix incorporating the sub-factors and multi- criteria perspectives.

• Utilized decision-making technique based on performed decision matrix to rank each group of factors.

• Applied the K-mean clustering in order to identify the critical factors in each group.

• SEM was used to analyze data related to examine the influence of factors on EMR acceptance and use.

Appendix

Appendix

1.1 Questionnaire

Authentication

EMR ensures that the patients’ information I send is transmitted to the right health care staff member, to whom I want to transmit it to.

EMR ensures that the patients’ information I receive are transmitted from the right health care staff member, to whom I want to receive it.

EMR ascertains my identity before sending any patients’ information to me.

EMR ascertains my identity before processing patients’ information received from me.

Nonrepudiation

EMR ensures that other healthcare staff will not deny having participated in patient information after processing it.

EMR ensures that other healthcare staff will not deny having sent me patient information.

EMR ensures that other healthcare staff will not deny having received patients’ information from me.

EMR ensures that other healthcare staff provide me some evidence to protect from the denial of having sent the patient information.

EMR ensures that other healthcare staff provides me some evidence to protect from the denial of having received the patient information.

Confidentiality

EMR ensures that all communications of EMR system are restricted to all authorized healthcare staff.

I am convinced that the received information will be treated with respect and confidentiality by other healthcare staff.

EMR uses some security controls (e.g. firewall) for the confidentiality of patient information.

EMR checks all communications between me and the other healthcare staff are protected against wiretapping or eavesdropping.

Data Integrity

EMR checks the patient’s information communicated with me for accuracy.

EMR takes steps to make sure that the transmission of the patient information is accurate.

EMR takes steps to make sure that the transmitted information of the patient information is not deleted.

EMR devotes time and effort to verify the accuracy of the patient information in transit process.

EMR system devotes time and effort to verify that the patient information in transit process is not deleted or tampered.

Availability

The probability of patient information system breakdown and information service disruption in my hospital is low.

A legitimate user with medical needs can access hospital patient information at any time and place.

The hospital ensures that a backup exists to tolerate hardware failure.

All servers should be continuously available to patients.

Trust

The hospital’s EMR system is trustworthy.

I trust in the benefits that came from the hospital’s EMR.

The hospital’s EMR system keeps its promises.

The hospital’s EMR keeps health care staff’s best interests in mind.

Even if not monitored I would trust the hospital EMR system to do job right.

I would use EMR than the traditional way of collecting patients’ information.

Implementing EMR system is the right policy of the hospital.

Collection

It usually bothers me when hospital asks for patient information.

When hospital asks patients for personal information, I sometimes think twice before recording it.

It bothers to give the patients’ information to other health care companies.

I’m concerned that hospital is collecting excessive information about patients.

Secondary use

A hospital should not use patient information for any purpose unless it has been authorised by the patient who provided the information.

When a patient gives personal information to a hospital for a particular reason, the hospital should never use that information for any other reason.

Hospital should never sell any of the patient information to third party.

Hospital should never share the patient information with other companies unless they gain approval from the patients to do so.

Unauthorised access

Hospital should devote additional time and effort to prevent unauthorised access to personal information.

Computer databases that contain patient information should be protected from unauthorised access – no matter how much it costs.

Hospital should take more steps to make sure that unauthorised people cannot access any of the patient information in its computers.

Error

All the patient information in computer databases should be verified for accuracy—no matter how much this costs.

Hospital should take additional steps to make sure that the information in the patients’ files is accurate.

Hospital should have improved procedures to correct errors in patient information.

Hospital should devote additional time and effort to verifying the accuracy of the patient information in its databases.

Effort Expectancy

The EMR can be used easily.

Learning to use the EMR is easy.

The process for using EMR is clear.

Using EMR system is not burden during the transition.

The hospital is self-solving when an error occurs.

Performance Expectancy

EMR accelerates the healthcare process.

The EMR enhances staff’s performance.

The EMR enhances the efficiency of your service.

The EMR enhances the accessibility and communication with the patient.

Social Influence

Your colleagues expect that your service improves via EMR system.

Your colleagues expect that you can use the EMR system efficiently.

The patient believes that the EMR system is very useful for your organisation.

The hospital supports training and attending seminars to increase their knowledge of EMR.

Facilitating Conditions

The hospital gives importance to service driven by EMR technology.

The hospital always improves and upgrades their EMR.

The hospital provides me with the required tools to use EMR.

The hospital supports training for new staff by a professional trainer.

The hospital provides the training for healthcare professionals whenever there is important system/technology.

Hedonic Motivation

Using EMR system makes your job fun.

Using EMR system makes your job enjoyable.

Using EMR system is very entertaining.

Time passes fast when using EMR system.

Habit

The use of EMR system has become a habit for me.

I always use EMR system.

I must use EMR system.

Using EMR has become natural to me.

Behavioural Intention

I want to use new technology to serve the patients.

I intend to continue using EMR system in the future.

I will try to use EMR system in my daily life.

I plan to continue using EMR system frequently.

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Enaizan, O., Zaidan, A.A., Alwi, N.H.M. et al. Electronic medical record systems: decision support examination framework for individual, security and privacy concerns using multi-perspective analysis. Health Technol. 10, 795–822 (2020). https://doi.org/10.1007/s12553-018-0278-7

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