AReviewofthe Technology Acceptance Modelin Electronic Health Records

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A Review of the Technology Acceptance Model in Electronic Health Records
Article in International Journal of Business and Technology Management · June 2023

DOI: 10.55057/ijbtm.2023.5.2.2
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International Journal of Business and Technology Management
e-ISSN: 2682-7646 | Vol. 5, No. 2, 8-19, 2023
http://myjms.mohe.gov.my/index.php/ijbtm
A Review of the Technology Acceptance Model in Electronic

Health Records
Al-Momani Ala’a1*, T. Ramayah1,2,3,4,5,6,7

1
School of Management, Universiti Sains Malaysia (USM)
2
Department of Information Technology & Management, Daffodil International University, Bangladesh (DIU)
3
Department of Management, Sunway University Business School (SUBS)
4
Azman Hashim International Business School, Universiti Teknologi Malaysia (UTM)
5
Applied Science Private University (ASU), Amman, Jordan
6
University Center for Research & Development (UCRD), Chandigarh University (CU), India
7
Faculty of Business, Economics and Social Development, Universiti Malaysia Terengganu (UMT), Malaysia
*Corresponding Author: [email protected]
Received: 15 March 2023 | Accepted: 1 May 2023 | Published: 1 June 2023
DOI: https://doi.org/10.55057/ijbtm.2023.5.2.2
__________________________________________________________________________________________
Abstract: Over the years, many theories and models have been proposed to explain and
interpret behaviours related to the acceptance and usage of technology. The technology
acceptance model (TAM), which has been tested in different technological applications, is the
most well-known of these models. This article reviews previously published research on the
application of TAM to electronic health records. According to the findings of this review, the
original TAM was updated and extended to fit the dynamic healthcare service environment by
absorbing and integrating variables from various theoretical frameworks as well as by adding
variables in specific contextual settings. This demonstrates how the TAM model has been
adapted and expanded to meet the specific demands of the healthcare industry, emphasising
its usefulness in various settings.
Keywords: TAM, technology acceptance model, EHR, review, perceived usefulness,

perceived ease of use, behavioural intention
___________________________________________________________________________
1. Introduction
In the 21st century, where digital technologies connect everyone, Information and
Communication Technology (ICT) plays an imperative role in improving the quality of several
aspects of the business world and people's daily lives. As a result, various sectors are attempting
to reap the full benefits of ICT by utilising new technologies to innovate existing systems and
transform traditional business practises to enhance society's growth, well-being, and economy.
Electronic health records system (EHR) is a digital version of a patient's health record that was
previously paper-based. EHR systems allow for the sharing of data with other healthcare
organisations such as specialists, pharmacies, medical imaging facilities, laboratories,
emergency facilities, and clinics. This provides better healthcare to patients by gathering
information from all clinicians involved in their care (Tanwar et al., 2019).
One of the most successful models and theories used over past years to understand, explain,
and predict how users accept and use new technologies is the Technology Acceptance Model
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(TAM). TAM has a significant impact on users' attitudes toward technology acceptance due to
its simplicity and understandability in explaining the attributes (Al-Qaysi et al., 2020; King &
He, 2006). Chintalapati and Daruri (2017) identified parsimony, verifiability, and
generalisability as features that should be fulfilled by any theory for understanding a difficult
situation. Consequently, TAM has been widely applied since it meets these three features.
2. Origin of TAM Model
Venkatesh et al. (2003) suggested the fundamental concept of user acceptance models, as
depicted in Figure 1. The core concept is that an individual's responses to technology use affect
their intention of usage, which ultimately leads to the actual usage. As a result, actual usage is
linked to an individual's responses to technology use.
Figure 1: Basic Concept Underlying User Acceptance Models (Venkatesh et al., 2003)
According to Davis et al. (1989), the Theory of Reasoned Action (Ajzen & Fishbein, 1980;
Fishbein & Ajzen, 1975) has proven to be effective in explaining and interpreting individuals’
behaviour in a variety of fields. Thus, they developed the TAM model from TRA to clarify and
explain the behaviour of computer usage. TAM was developed to assess users' acceptance of
technology, clarify the factors that impact the acceptance, and explain the users' attitudes
towards various technologies. In other words, the primary goal of TAM was to establish a basis
for measuring how external influences affect users' internal attitudes, beliefs, and intentions
(Davis et al., 1989). Figure 2 illustrates the TAM model.
Figure 2: Original Technology Acceptance Model (TAM) (Davis et al., 1989)
Davis et al. (1989) defined perceived usefulness (PU) as the extent to which an individual
believes that system usage would enhance his/her performance at the workplace. Perceived
ease of use (PEOU) was defined as the degree of user’s expectations that system usage would
involve little effort (Davis et al., 1989). Original TAM had been modified in different models.
For instance, Venkatesh and Davis (2000) proposed TAM2 by introducing additional
constructs (see Figure 3).
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Venkatesh and Bala (2008) developed an integrated model, TAM3, by merging TAM2
(Venkatesh & Davis, 2000) with the determinants of the perceived ease of use model
(Venkatesh, 2000). This model outlines several factors that impact an individual's technology
acceptance and usage. The TAM3 model comprises additional constructs, as illustrated in
Figure 4.
Figure 3: Proposed TAM2-Extension of the Technology Acceptance Model (Venkatesh & Davis, 2000)
Figure 4: Integrated Technology Acceptance Model 3 (TAM3) (Venkatesh & Bala, 2008)
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3. TAM Model and EHR in Previous Studies
According to Google Scholar, the article of Davis (1989) was cited 75,527 times to date (16
March, 2023). This statistic served as motivation to look at the role of the TAM model in the
EHR setting. Table 1 summarises the prior studies of TAM model in context of EHR. It shows
the model/theory, context, constructs, and results.
4. Discussion
As stated in Table 1, EHR technology has been studied in different contexts in developed and
developing countries. Moreover, TAM model was extended with various external variables,
which were deemed significant in some studies but not in others (see Table 2). Additionally,
some studies did not incorporate any external variables at all. One explanation for this
inconsistency can be attributed to the country where the research was conducted, as the usage
of such variables can vary across different countries, therefore, they should be adapted to the
context of countries. According to Straub et al. (1997), theories and models pertaining to
technology users are not equally applicable in all contexts. Moreover, Sun and Zhang (2006)
noted that the effects of certain characteristics on technology usage are inconsistent across
studies.
In addition to that, most of these studies used TAM without integration with other theories.
One justification for this issue might be that the TAM model is widely regarded as one of the
most efficient models created for explaining an individual's adoption and usage of any
technology. Due to its simplicity and understandability in explaining its attributes (Al-Qaysi et
al., 2020; King & He, 2006).
5. Limitations of the TAM Model
According to Davis et al. (1989), TAM was developed specifically for computer usage
behaviour. While, Davis (1989), in the initial TAM model, recommended investigating the
influence of external factors on the primary constructs of TAM, which are perceived usefulness
and perceived ease of use. Over the years, TAM has been extensively used in management
information systems (MIS), and several modifications and adjustments have been proposed for
TAM. This includes integrating factors from several theories and making adaptations that meet
specific requirements.
The most common critique of TAM in context of Heath Information Technology (HIT) is its
oversimplification (Shachak et al., 2019). Although the simplicity of TAM makes it a tool for
assessing the acceptability of the technologies usefully or assessing different needs of several
groups of users, it reduces the model's explanatory and provide little penetration into the actual
usage of HIT (Shachak et al., 2019). Moreover, several studies in HIT simplified the model to
just three constructs: perceived usefulness, perceived ease of use, and usage intention.
Table 1: Summary of Previous Studies of EHR Technology

Authors Theory Context Variables Findings of the study
Attitude, TR, and PU
IV: Trust (TR), Perceived Risk
254 determined physicians’
Egea and (PR), Information Integrity
physicians in intention to use EHCR;
González TAM (INTG), PEOU, PU, Attitude
Southern moreover, TR had a strong
(2011) DV: Behavioural intention
Spain effect on PU, PEOU, and
(BI)
attitude; in addition, TR fully
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mediated the relation between

PR and INTG
PU and ASI had a significant
100
IV: Access to Shared and positive impact on the
physicians
Terrizzi et Information (ASI), Trust (TR), intention to use HER; in
TAM and office
al. (2012) PU, PEOU addition, PEOU had
staff in
DV: Behavioural Intention (BI) significant and positive impact
Pennsylvania
on PU
334
undergraduate
and PU and attitude were
Gajanayak postgraduate IV: PU, Attitude positively related to the BI to
e et al. TAM students of DV: Behavioural Intention adopt HER; attitude partially
(2013) medical, (BI) mediated the effect of PU on
nursing, and the intention to adopt EHR
other staff in
Australia
IV: PU, PEOU, Computer
Self-Efficacy (CSE),
Demonstrability of the Results PEOU, PN, SN and DR
(DR), Resistance to Change predicted physicians’ intention
157 (RC) Information about to use the EHR strongly; the
Gagnon et
TAM physicians in Change (IC), Personal Identity impact of determinants on
al. (2014)
Canada (PI), Social Norm (SN), intention was affected by age,
Professional Norm (PN), gender, prior experience, and
Computer Self-Efficacy (CSE) area of expertise
DV: Behavioural Intention
(BI)
307 IV: PU, Social Influence (SI), PC, SI, and Experience had a
Steininger physicians in Experience, Privacy Concerns significant
et al. TAM private (PC), ATT impact on the PU; moreover,
(2014) practices in DV: Behavioural Intention PU had a significant impact on
Austria (BI) attitude and BI
IV: PEOU, PU, Perceived
Al-Adwan 222 SI, PTH, PEOU and PU
Threat (PTH), SI
and Berger TAM physicians in influence EHR adoption
(2015) Jordan decision of physicians
(BI)
Kowitlawa 212 nursing IV: Self-Efficacy, PU, PEOU, All the hypothesis were
kul et al. TAM students in Attitude accepted; attitude was the most
(2015) Singapore DV: Behavioural Intention (BI) influential factor for BI
Complexity and reliability
significantly influenced PU;
187 health IV: System Characteristics complexity and PU
Sintonen professionals (complexity, reliability), PU, significantly influenced the BI;
TAM and
et al. in south- BI, Perceived Behavioural but reliability had no impact
TPB
(2015) eastern Control (PBC) on BI; BI influenced actual
Finland DV: Actual Use usage; while, PBC had no
influence on BI or actual usage
of EHR
IV: Privacy Concerns (PC), SI, HIT experience, and PC
Steininger
307 Social Influence (SI), HIT had a significant effect on the
and
TAM physicians in Experience, PU, Attitude PU; which in turn had an
Stiglbauer
Austria DV: Behavioural Intention impact on attitude as well as
(2015)
(BI) the BI
172 IV: Image, Computer Skills Image, COMS, SN, PEOU and
Alipour et physicians (COMS), Subjective Norms PU affecting the acceptance of
TAM
al. (2016) and nurses in (SN), PEOU, PU HIS by physicians and nurses;
Iran DV: Behavioural Intention (BI) PEOU had no effect on the BI
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The external factors were

identified as direct
IV: External Predictors, Other determinants of BI; other
Beglaryan 233
factors, PEOU, PU, factors have an indirect
et al. TAM physicians in
Behavioural intention (BI) influence on the BI through
(2017) Armenia
DV: Actual Use their impact on projected
collective usefulness, PU, and
PEOU
IV: PU, PEOU, Privacy, Trust, PEOU and PU and trust
Hoque et 350 patients in Behavioural Intention (BI), significantly influencing BI;
TAM
al. (2017) Bangladesh Gender while privacy was identified as
DV: Actual Use a less significant factor
Jordanian nurses demonstrated
IV: PU, PEOU, Behavioural a positive perception of PU
Tubaishat 1539 nurses in
TAM Intention (BI) and PEOU, which affect
(2017) Jordan
DV: Actual Use nurses’ acceptance to use
EHRs
IV: Misfit, Data Security (DS),
Vitari and Computer Self Efficacy (CSE), ANX, CSE, TRS influence
Ologeanu- 1427 clinical Anxiety (ANX), Trust (TRS), PEOU; PU, misfit, CSE, DS
TAM
Taddei employees PU, PEOU impact PU; PU and PEOU
(2018) DV: Behavioural Intention contribute to BI
(BI)
IV: PU, Information Sharing
(INFS), Staff IT Experience
Zayyad
465 healthcare (ITE), Technical PU, belief, willingness, and
and
TAM professionals Infrastructures (TINF), attitude have a significant
Toycan
in Nigeria Security (SEC), Attitude influence on the BI
(2018)
(BI)
241
Habit significantly increases
physicians, IV: Habit, PEOU, PU, Attitude
Alsharo et PU and PEOU, which
TAM nurses, and DV: Intention to Continuous
al. (2020) improves physicians and
pharmacists in Usage
nurses’ attitudes
Jordan
IV: Privacy Concerns (PC),
Dhagarra PU, PEOU, TR and PC
416 patients in Trust (TR), PEOU, PU
et al. TAM directly predict patients’
India DV: Behavioural Intention
(2020) behaviour to accept technology
(BI)
IV: PU, PEOU, Staff IT
PU, PEOU, TI and ATT had a
384 healthcare Experience (ITE), Technical
Kalayou et significant influence on BI;
TAM professionals Infrastructure (TI), Attitude
al. (2020) while the effect of ITE on the
in Ethiopia DV: Behavioural Intention
BI was not significant
(BI)
IV: Subjective Norms (SN),
PU, PEOU, Image (IMG), Job
Relevance (JR), Output
Quality (OQ), Result SN, JR, OQ, VLN, CEXP
Demonstrability (RD), have significant impacts on
Voluntariness (VLN), PU; also, PEC and ANX were
Ebnehosei
244 EHR Computer Experience (CEXP), identified as having significant
ni et al. TAM3
users in Iran HIS Experience (SEXP), impacts on PEOU; PU did not
(2020)
Self‑Efficacy (CSE), Computer mediate RD and BINT. PEOU
Anxiety (ANX), Perception of mediate CSE and BINT, and
External Control (PEC), PENJ
Perceived Enjoyment (PENJ)
(BI)
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IV: PU, PEOU, Resistance to

Change (RC), Perceived Value
(PV), Colleagues’ Opinions
TAM1, (CO), Self-Efficacy for All seven factors were strongly
Cho et al. 223 nurses in
TAM2, Change (SE), Organaisational linked to user resistance, either
(2021) Korea
TAM3 Support (OS), Experience directly or indirectly
(EXP)
DV: User resistance behaviour
(UR)
IV: General Data (GD), Use of
GD, UC, TPS, EOU, PU, and
Pavlovic 156 Computers (UC), Technical
attitude identified as
et al. TAM physicians in Performance Satisfaction
determinants of system
(2021) Serbia (TPS), PEOU, PU, Attitude
acceptance
DV: Acceptance of System
IV: Age, Gender, IT-
200 Doctor Competency, PU, PEOU, There was a significant
Saare et al.
TAM and nurse in Attitude relationship between PEOU,
(2021)
Iraq DV: Behavioural Intention PU, Attitude, and BI
(BI)
IV: System Quality (SQ),
Information Quality (IQ), ORG and PEOU impacted the
346 clinical
Yoo et al. TAM & Service Quality (SevQ), use of system; while SQ, IQ,
experts in
(2022) UTAUT PEOU, Trend, Organaisation SevQ and Trend did not affect
Korea
(ORG) system usage
DV: Use
Table 2: Variables Supportation from Previous Studies

Frequency of Frequency of not-
IV DV
Supported effect supported effect
Perceived usefulness Behavioural intention 8 2
Perceived ease of use Behavioural intention 6 2
Perceived usefulness Attitude 7
Perceived ease of use Attitude 5
Perceived ease of use Perceived usefulness 12
Attitude Behavioural intention 6
Behavioural intention Use 3
Perceived ease of use Use 1
Biometric authentication Perceived ease of use 1
Single sign on Perceived ease of use 1
Multi-system access Perceived ease of use 1
System quality Perceived ease of use 1
Information quality Perceived ease of use 1
Service quality Perceived ease of use 1
Organaisation Use 1
Trend Use 1
Trust Behavioural intention 1 2
Trust Perceived usefulness 2
Trust Perceived ease of use 1 1
Trust Attitude 1
Privacy concern Behavioural intention 3
Privacy concern Perceived usefulness 1
Privacy concern Perceived ease of use 1
Privacy concern Attitude
Habit Perceived usefulness 1
Habit Perceived ease of use 1
Attitude Intention to continuous use 1
Perceived usefulness Intention to continuous use 1
Personal innovativeness Perceived ease of use 1
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Personal innovativeness Behavioural intention 1

Related knowledge Perceived ease of use 1
Related knowledge Behavioural intention 1
Computer anxiety Perceived ease of use 1
Computer anxiety Behavioural intention 1
Patient influence Perceived usefulness 1
Patient influence Perceived ease of use 1
Patient influence Projected collective usefulness 1
Patient influence Behavioural intention 1
Resistance to change Perceived usefulness 1
Resistance to change Perceived ease of use 1
Resistance to change Projected collective usefulness 1
Resistance to change Behavioural intention 1
Organizational support Perceived usefulness 1
Organizational support Perceived ease of use 1
Organizational support Projected collective usefulness 1
Organizational support Behavioural intention 1
Security Perceived usefulness 1
Security Perceived ease of use 1
Security Projected collective usefulness 1
Security Behavioural intention 1
Administrative monitoring Perceived usefulness 1
Administrative monitoring Projected collective usefulness 1
Administrative monitoring Behavioural intention 1
Professional relationships Perceived usefulness 1
Professional relationships Projected collective usefulness 1
Professional relationships Behavioural intention 1
Organizational change Perceived usefulness 1
Organizational change Projected collective usefulness 1
Organizational change Behavioural intention 1
Perceived ease of use Projected collective usefulness 1
Perceived usefulness Projected collective usefulness 1
Behavioural intention Projected collective usefulness 1
Social influence Behavioural intention 3
HIT experience Behavioural intention 2
Social influence Perceived usefulness 1 1
HIT experience Perceived usefulness 2
HIT experience Attitude 2
Demonstrability of the Results Perceived usefulness 1
System complexity Perceived usefulness 1
System reliability Perceived usefulness 1
System complexity Behavioural intention 1
System reliability Behavioural intention 1
Perceived behavioural control Behavioural intention 1
Perceived behavioural control Use 1
Computer self-efficacy Perceived usefulness 1
Computer self-efficacy Perceived ease of use 2
Perceived threat Behavioural intention 1
Perceived threat Perceived usefulness 1
Perceived threat Perceived ease of use 1
Social Norm Behavioural intention 1
Professional Norm Behavioural intention 1
shared information Behavioural intention 1
Perceived risk Trust 1
Information integrity Perceived risk 1
Information integrity Trust 1
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Consequently, the outcomes usually oriented around intended or perceived use, rather than the
actual use of the technology under examination (Shachak et al., 2019). Furthermore, TAM
partially takes a limited perspective of ICT diffusion and use, focusing on a user and assuming
a direct causal influence of intention on the user's actual behaviour (Shachak et al., 2019). In
addition, not all factors that impact the intention to accept and use technology are covered by
the TAM model (Mutahar et al., 2018). It only focuses on technological factors by proposing
PU and PEOU and ignores other significant factors that affect technology usages, such as
individual, organisational, task, and social factors.
Moreover, TAM disregards the assessment of IT evaluation factors, such as performance

impact, which is used to evaluate the success of information systems (Isaac et al., 2017, Isaac
et al., 2019). In addition, several studies have excluded the "attitude" variable from the final
model of TAM due to empirical data, as attitude did not act as a mediator between the effects
of PU and PEOU on intention (Davis et al., 1989).
6. Conclusion
The healthcare sector is continually adopting new technologies, including modern and
innovative ICT. The use of technology has been demonstrated to enhance the quality of
healthcare services, improve staff performance, ensure patient safety, and reduce organisational
expenses. The TAM model is a well-established model used to interpret and explain technology
acceptance by users. TAM has been expanded to include various external factors. However,
some studies have used TAM in isolation without integrating other theories. Since the usage of
these factors varies across countries, it is essential to adapt them to the specific context of each
country.
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A Review of the Technology Acceptance Model in Electronic Health Records

Article in International Journal of Business and Technology Management · June 2023

Ala'a M. Al-Momani Ramayah T.

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A Review of the Technology Acceptance Model in Electronic

Al-Momani Ala’a1*, T. Ramayah1,2,3,4,5,6,7

*Corresponding Author: [email protected]

Received: 15 March 2023 | Accepted: 1 May 2023 | Published: 1 June 2023

Keywords: TAM, technology acceptance model, EHR, review, perceived usefulness,

2. Origin of TAM Model

Figure 2: Original Technology Acceptance Model (TAM) (Davis et al., 1989)

3. TAM Model and EHR in Previous Studies

5. Limitations of the TAM Model

Table 1: Summary of Previous Studies of EHR Technology

mediated the relation between

The external factors were

IV: PU, PEOU, Resistance to

Table 2: Variables Supportation from Previous Studies

Personal innovativeness Behavioural intention 1

Moreover, TAM disregards the assessment of IT evaluation factors, such as performance

and Informatics, 34(6), 853–860. https://doi.org/10.1016/j.tele.2016.08.008.

Model: Four Longitudinal Field Studies. Management Science, 46(2), 186–204.

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