Physicians’ acceptance of electronic medical records exchange: An extension of the decomposed TPB model with institutional trust and perceived risk

• EMR exchange has played a crucial and central role in health care.
• Physicians play a key role in the acceptance of EMR exchange in Taiwan.
• This study proposes a theoretical model to explain the behavior of physicians.
• The results indicate that the PBC was the strongest factor on intention to use.
• The effect of institutional trust was partially mediated by the physician perceptions on risk.

PurposeElectronic medical records (EMRs) exchange improves clinical quality and reduces medical costs. However, few studies address the antecedent factors of physicians’ intentions to use EMR exchange. Based on institutional trust and perceived risk integrated with the decomposed theory of planned behavior (TPB) model, we propose a theoretical model to explain the intention of physicians to use an EMR exchange system.MethodsWe conducted a field survey in Taiwan to collect data from physicians who had experience using the EMR exchange systems. A valid sample of 191 responses was collected for data analysis. To test the proposed research model, we employed structural equation modeling using the partial least squares method.ResultsThe study findings show that the following five factors have a significant influence on the physicians’ intentions to use EMR exchange systems: (a) attitude; (b) subjective norm; (c) perceived behavior control; (d) institutional trust; and (e) perceived risk. These five factors are predictable by perceived usefulness, perceived ease of use, and compatibility, interpersonal and governmental influence, facilitating conditions and self-efficacy, situational normality and structural assurance, and institutional trust, respectively. The results also indicate that institutional trust and perceived risk integrated with the decomposed TPB model improve the prediction of physician's intentions to use EMR exchange.ConclusionThe results of this study indicate that our research model effectively predicts the intention of physicians to use EMR exchange, and provides valuable implications for academics and practitioners.