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Open Access Research article

Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study

Murali Sambasivan1*, Pouyan Esmaeilzadeh2, Naresh Kumar3 and Hossein Nezakati4

Author Affiliations

1 Global Entrepreneurship Research and Innovation Center (GERIC), Universiti Malaysia Kelantan, Kelantan, Malaysia

2 Graduate School of Management, Universiti Putra Malaysia, Putra, Malaysia

3 Global Entrepreneurship Research and Innovation Center (GERIC), Universiti Malaysia Kelantan, Kelantan, Malaysia

4 Faculty of Economics and Management, Universiti Putra Malaysia, Putra, Malaysia

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BMC Medical Informatics and Decision Making 2012, 12:142  doi:10.1186/1472-6947-12-142

Published: 5 December 2012

Abstract

Background

Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician’s perceived professional autonomy, (2) involvement in the decision to implement CDSS and (3) the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested.

Methods

A questionnaire-based survey conducted between July 2010 and December 2010. The study was conducted in seven public and five private hospitals in Kuala Lumpur, Malaysia. Before contacting the hospitals, necessary permission was obtained from the Ministry of Health, Malaysia and the questionnaire was vetted by the ethics committee of the ministry. Physicians working in 12 hospitals from 10 different specialties participated in the study. The sampling method used was stratified random sampling and the physicians were stratified based on the specialty. A total of 450 physicians were selected using a random number generator. Each of these physicians was given a questionnaire and out of 450 questionnaires, 335 (response rate – 74%) were returned and 309 (69%) were deemed usable.

Results

The hypotheses were tested using Structural Equation Modeling (SEM). Salient results are: (1) Physicians’ perceived threat to professional autonomy lowers the intention to use CDSS (p < 0.01); (2) Physicians involvement in the planning, design and implementation increases their intention to use CDSS (p < 0.01); (3) Physicians belief that the new CDSS will improve his/her job performance increases their intention to use CDSS (p < 0.01).

Conclusion

The proposed model with the three main constructs (physician’s professional characteristic, involvement and belief) explains 47% of the variance in the intention to use CDSS. This is significantly higher than the models addressed so far. The results will have a major impact in implementing CDSS in developing countries.

Keywords:
Clinical decision support system; Professional autonomy; Performance expectancy; Effort expectancy,Participation in decision making; Intention to use; Physicians; Malaysia