Objective: The primary objective of this paper is to identify the main factors which have an impact on the users' attitude towards the functionalities representing the perceived ease of use and to those representing the perceived usefulness. Another objective is to examine whether there occurred a shift towards the perceived usefulness of users' behavior over a period of time. To support these objectives, two different cases are examined - the case in which users are simultaneously offered basic and updated functionalities, and the one in which users are offered a completely new set of features. The results of this study are expected to exert a significant impact on a further development of new software components, as well as the updates of the existing ones.
Material and methods: As the starting point, there were employed the user behavior indicators defined in similar researches and conducted in the countries with a similar cultural background or with a comparatively similar national healthcare system. What ensued was an updated set of functionalities offered within the electronic health record based medical information system. Instead of the survey being posted, the effects of implanted updates were measured through the analysis of the collected data. The data collected in the Nis Primary and Ambulatory Care Center during a four-year period represented the material used in the research. The obtained records indicating the usage of the initial and updated visit registration form, as well as the usage of the new types of visits, were examined in relation to the technology acceptance model and integrated behavior model.
Results: The response to the initial functionalities, perceived as easy to use, was high as expected since they kept the users in their "comfort zone". As regards the updated features, the ones corresponding to the perceived usefulness, the initial overall acceptance rate was 60%, while the overall increase of their acceptance was around 20%. The overall usage of the newly introduced features was doubled in some cases throughout the four-year period, while some of them were not accepted as expected.
Discussion: Carefully designed additional functionalities, aimed to improve the most common daily activities, have a significant potential to be accepted by the medical professionals. The shift from the perceived ease of use to the perceived usefulness is not uniform, nor is its use in different departments or by the users of the same department. A higher acceptance rate was observed in the departments with more complex administrative procedures, as well as among the users having contacts with more patients and using the system for a longer period.
Conclusion: When accepting new features, medical professionals will initially choose the simpler ones with obvious benefits. If the usage of a feature triggers indirect benefits, the number of examined patients is of a crucial importance for the acceptance of that feature. In the event of the advanced functionality with an extended set of options competing with the simple functionality covering basic requirements, the latter will be used. A feature design, together with a proper training, system stability and ensuring utilization, represent a key point for increasing the positive impact that the information system can have in many application areas, including the healthcare.
Keywords: Integrated behavior model; Medical information system; Perceived ease of use; Perceived usefulness; Technology acceptance model.
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