Electronic health record portals adoption by health care consumers

Research output: ThesisDoctoral Thesis


Electronic Health Record (EHR) portals, also called EHR patient portals, have received great attention and investment at the government level worldwide, like the multi-billion dollar US initiative, named meaningful use program. According to the literature review, there is still a lack of studies that address the topic of understanding why people adopt and use EHR Portals, making this a field of knowledge that requires more research. According to the findings in the literature
review the complexity of EHR portals requires having a patient-centred model that should be able to cover additional dimensions related with health behaviour, confidentiality concerns, and innovation drivers. Potential adoption differences between countries with different regulations in their health care systems should also be tested. With this dissertation, we contribute to a better understanding of the factors that lead health care consumers to use and adopt EHR portals. To
this end we develop four empirical studies.
In the first empirical study (Chapter 3) we tested the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) in Portugal. Being a consumer- centred model, it was important to evaluate its feasibility to study the EHR portals adoption determinants by the health care consumers. Several constructs in the model helped explain the adoption of EHR portals:
performance expectancy, effort expectancy, social influence and habit. With habit a consumer specific construct from UTAUT2 having the most relevant impact in both behavioural intention and use. UTAUT2 showed its importance as a consumer-focused model identifying the factors that drive health care consumers to use EHR portals.
In the second empirical study (Chapter 4) -also tested in Portugal- we extended the UTAUT2 model by adding a health specific construct, self-perception. This construct showed its relevance by being a statistically significant predictor of behavioural intention, demonstrating the usefulness of including a construct derived from the Health Belief Model (HBM), in a technology applied in
the field of health care.
In the third empirical study (Chapter 5) we performed a cross-country analysis between US and Portugal combining UTAUT2 with the Concern for Information Privacy (CFIP) framework. We made an assessment of the potential differences between the determinants of adoption between the two countries with different health care regulations and health care models. In the US there is no national health system (NHS) coverage and the patients need to have an expensive private
insurance or pay directly to the health care provider to have health care support, while in Portugal there is universal health coverage. It was hypothesized and confirmed via the price value construct that the value that the US health care consumers give to a tool like EHR portals is statistically significantly greater than the Portuguese health care consumers. It was also expected that confidentiality concerns in US are greater than in Portugal, due to the less strict regulation in US
regarding patient data confidentiality. This was measured by the CFIP framework, but confidentiality concerns were not an issue in either US or Portugal. Social influence, hedonic motivation, and price value were predictors only in the US group. With this study we verified the importance to perform cross-country evaluations when studying EHR portals adoption.
In the fourth empirical study (Chapter 6) we used the evidence from the previous empirical studies plus the literature review to propose a new research model that integrates constructs from UTAUT2, HBM, and the Diffusion of Innovation (DOI) theory. In this study, we performed a national survey based on randomly generated mobile phone numbers, when in the previous empirical research, we targeted our sample to educational institutions. We used a two-phase
sampling approach. In the first phase, we asked potential respondents if they were users of EHR portals and if yes, if she/he was interested in replying to our main survey (second phase). From this sample regarding the question to identify the users of EHR portals, we obtained 8.6% EHR portals usage in the adult Portuguese population. A relevant contribution from our study to understand the usage of this type of technology at country level. All three theories contributed
with constructs that help to understand EHR portals adoption. The final research model obtained the best results from the all of the empirical studies executed in this dissertation with 76.0% of variance explained in behavioural intention and 61.8% of variance explained in use behaviour.
In this dissertation’s conclusions (Chapter 7), we provide more detailed insights about the overall contributions of this dissertation, managerial implications to develop and implement better EHR portals, limitations and avenues for future research about EHR portals.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • NOVA Information Management School (NOVA IMS)
  • Oliveira, Tiago, Supervisor
Award date30 Jan 2018
Publication statusPublished - 30 May 2018


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