دانلود رایگان مقاله انگلیسی ارزیابی یکپارچه مدل پیوندی سیستم های اطلاعاتی (UMISC) در دو محیط بیمارستان - الزویر 2018

Abstract

Context: The deployment and long-term acceptance of clinical information systems (CISs) are faced with multiple difficulties. They include insufficient quality of the systems in place and resistance to the multiple changes they induce in care processes. Permanent evaluation of deployed solutions is a prerequisite to their continuous improvement. Objective: The purpose of this study was twofold: (1) To validate the post-adoption unified model of information system continuance (UMISC) progressively developed at the Georges Pompidou University Hospital (HEGP) in Paris (internal validation); and (2) To compare, using the same evaluation model, the results observed at HEGP with those of the Saint-Joseph Hospital Group (HPSJ), another Paris acute care institution (external validation). Methods: The UMISC post-adoption model is built around nine dimensions: end-user characteristics, social norm (SN), IS quality (ISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), profession-adjusted use (PAU), satisfaction (SAT), and continuance intention (CI). Two semi-quantitative evaluation surveys were performed at HEGP in 2014 and 2015, and one at HPSJ in 2015. Statistical analysis included multiple regression analysis and structural equation modeling (SEM). Results: The analysis concerned 459 responders, 264 at HEGP and 195 at HPSJ. UMISC indicators, with the exception of SN, are superior at HEGP than at HPSJ, which had a shorter CIS anteriority than HEGP. In SEM analysis, the UMISC model explained 25% and 40% of the CIS use, 92% and 93% of health professionals’ satisfaction, and 72% and 71% of continuance intention at HEGP and HPSJ, respectively. Seventeen of the 21 tested UMISC hypotheses were supported in at least one of the two sites. Conclusion: The UMISC evaluation model can be used as a comparison and explanatory model of CIS use, satisfaction and continuance intention in post-CIS adoption situations that become prevalent in current electronic hospitals.

5 Discussion and conclusion

5.1 Study results

The deployment and long-term acceptance of clinical information systems (CISs) are faced with multiple difficulties. They include insufficient quality of the deployed systems and resistance to the multiple changes in care processes they induce. Permanent evaluation of deployed CIS solutions is therefore a prerequisite to their continuous improvement [34]. It should consider, among other factors, the choice of the evaluation model with its different constructs, the timing of evaluation regarding the phase of IT project, the exact nature of the IT system, and the target professional end-user population. This paper addresses late and very late CIS post-adoption situations that are becoming prevalent in most hospitals or medical practices. The evaluation concerns the entire CIS considered here a black box and not its CIS parts or components (e.g., the CPOE, the PACS), and a multi-professional group of end-users including physicians, nurses, and secretaries and social workers in direct contact with patient health records. Thanks to usability-driven studies and more and more integrated interfaces and workflows, end-users are unlikely to know which part of a complex system there are using at instant t. They are also susceptible to evaluate a system on the basis of its weakest part.