Technology acceptance model: Factors influencing consumers' intent to use Electronic Personal Health Records

Health care providers are stepping-up efforts to develop and implement a national health record system consistent with the goals of advancing information sharing and enhancing access to the critical information that underlies the delivery of quality care. In view of electronic advances, the adoption of a national Health Information Exchange System (HIES) that utilizes online data storage services and systems has become more relevant than ever. In addition to the relevance and timeliness for operationalizing such a system, there is the need to identify and understand factors that might contribute to consumers' intent to adopt and use an Electronic Personal Health Records (ePHR) as part of the nationalized HIES.;This study focuses on the identification and analysis of specific factors that might contribute to or inhibit consumers' intent to use such a system. The researchers developed the survey tool based on the Technology Acceptance Model (TAM), incorporating constructs of the Theory of Reasoned Action (TRA) and its derivative, the Theory of Planned Behavior (TPB). More specifically, the integrated elements of the scale (TAM, TRA and TPB) guide the selection of external factors that might affect potential users' attitude towards the use of ePHRs (positive or negative) that, in turn, might predict their behavioral intention to use an ePHR. In addition to considering the multiple dimensions (10 constructs and 16 hypotheses) of the enhanced model, the study examined the moderating effect of gender on the relationship between attitude and intent to use ePHR. This study is an exploratory analysis of data collected from a convenience sample of students from two Midwestern universities. They responded to an email invitation to participate in an on-line interactive survey entitled "Electronic Record Acceptance Tool" (ERAT) that was designed based on measurement scales validated in prior research. Data from 604 respondents were analyzed using Structural Equation Modeling (SEM) to identify correlations and latent variable relationships that guided consumers' intent to use ePHR. The sample consisted of 18-50 year old college students, the majority (70%) of whom were between 18 and 25 years old. Female students comprised the majority (51%) of study participants.;From the 21 hypothesized paths in the model, 12 paths were statistically significant in relationships that guided the intent to use ePHR. Attitude towards the use of ePHR was significantly and positively related to behavioral intent to use ePHR. Perceived ease of use was positively related to consumers' attitude toward the use of ePHRs and perceived usefulness of ePHR. Perceived usefulness was positively related to consumers' attitude toward the use of ePHRs. Privacy concerns (collection, improper access, secondary use) were negatively related to perceived ease of use. Privacy concerns (secondary use) were negatively related to perceived usefulness. Security concerns were negatively related to perceived usefulness and perceived ease of use. Enablement was positively related to perceived usefulness and ease of use of ePHR. Trust in health care providers was positively related to perceived ease of use of ePHR. The researchers determined that 35% of the variance associated with behavioral intent is accounted for by attitude toward using ePHR. Perceived usefulness and ease of use explained 32% of the variance associated with attitude toward using ePHR. The external variables accounted for 39% and 23% of the variance associated with, respectively, perceived usefulness and perceived ease of use. Finally, four out of the six relationships to perceived usefulness and perceived ease of use were significantly stronger for study participants under 30 years old than for those from other age categories. The relationship of females' attitude toward using ePHR and behavioral intent to use ePHRs was much stronger. Although 88% of the respondents did not use ePHRs, 61% indicated they would be willing to carry a secure credit card-sized ePHR record with them.;The study demonstrates that underling external inhibiting and facilitating variables predict users' attitude towards using ePHR. Elements of privacy concern and security concern, enablement and health care provider trust influence perceived usefulness and ease of use in the acceptance of an ePHR, an electronic health management and communication technology system.