Running title: NURSES’ acceptance ON ECD IeJSME 2021 15 (2): 5-18 Perception of nurses on ease of use, usefulness and system quality of electronic clinical documentation (ECD) at private hospitals in Klang Valley, Malaysia Syakinah Anian1,2, Mariani Ahmad Nizaruddin3, Goventhamah Subramaniam4, Jayanthi Marimuthu5, Shalizah Sujak6 ABSTRACT Keywords: Medical record, computerised, Electronic clinical documentation, Technology Acceptance Model, Introduction: The health information system Nurses with efficient processes and development in healthcare technology including an electronic clinical Introduction documentation (ECD) reporting draws the interest of a large number of people. Widespread expansion Recently, the healthcare sector is one of the leading of the use of ECD is known to be advantageous to industries that serves high impact quality service and the health information system, however a workload treatment. With regards to this, the electronic clinical is often questionable for healthcare professionals and documentation (ECD) in the health information system productivity practices. The aim of this study is to analyse incorporated with supporting characteristics that are the perception of nurses in regards to the relationship manageable and faster, leading to the efficient hospital between perceived ease of use, perceived usefulness and services (Ismail et al., 2015), will enable enhanced perceived system quality of ECD system. legibility, systematic storage, and immediate retrieval of notes. The system allows synchronised use of medical Methods: The cross-sectional survey comprised of record by several users, improves security and privacy, a population of nurses practising in clinical settings and facilitates research (Hedian et al., 2018). This system at private hospitals in Klang Valley, Malaysia. A total is beneficial in protecting the privacy and personal of 324 questionnaires was collected by using stratified rights of the patient, as well as safety, quality of care and random sampling with a 99% response rate. Smart-PLS management of health information. The consistency was used to analyse the relationship between the latent and capacity of this system to provide information as variables. well as resources depend on the regular process between Results: The perceived ease of use, perceived providers of healthcare, including physicians, nurses, usefulness and perceived system quality have a allied health, and other medical stakeholders (Aldosari significantly positive influence, resulting in a positive et al., 2018). impact on the perception of nurses. The results of this 2 The new technology triggered many hopes, fears, and research showed that the model’s R value was scored grumbles among healthcare professionals on the ECD at 0.743, which indicated that 74.3% of the variance system. The transformed system from the paper-based in perception on ECD was collectively explained by the medical record to the electronic system is likely to disrupt three exogenous latent variables. the events or workflow in a hospital setting. There is Conclusion: Positive perception on ECD system sometimes a questionable burden of work for healthcare could be used as prediction on the acceptance by the professionals and productivity practices (Koneko et al., user/nurses. This study is useful for top management and 2018). Previous study by Mehrotra et al. (2016) reported policymakers to strategise on ECD’s implementation. various challenges and effect after implementation of this system, including ineffective workarounds, disruptions 1School of Business and Management, KPJ Healthcare University College, Negeri Sembilan, Malaysia 2Faculty of Business and Technology, University of Cyberjaya, Selangor, Malaysia 3Department of Community Pharmacy Practice, Faculty of Pharmacy, University of Cyberjaya, Selangor, Malaysia 4KPJ Tawakal Specialist Hospital, Kuala Lumpur, Malaysia 5KPJ Damansara Specialist Hospital, Selangor, Malaysia 6KPJ Seremban Specialist Hospital, Negeri Sembilan, Malaysia Address for Correspondence: Syakinah Anian School of Business and Management, KPJ Healthcare University, Kota Seriemas, Nilai, Negeri Sembilan Email: [email protected] 5 Nurses’NURSES’ acceptAacceptanceNCE ON ECD IeJSME 2021 15 (2): 5-18 in continuity of care, and other electronic errors. The technology and explain actual use of that technology. concern of the healthcare employee on the ECD system The goal of this study was to explore the perception is whether it is an instrument that can communicate of nursing staff adopting the electronic technology more proficiently about clinical care, or whether it has system in the healthcare sector in Malaysia. In order to its ability to fast check medication orders and clinical examine the factors influencing the attitudes of nursing resolution support which holds the key to increasingly staff towards the application and implementation of accurate diagnoses (Hedian et al., 2018). the ECD, two variables from the Technology Adoption Model (TAM) were added. According to Davis’ (1989) Therefore, it is noteworthy to determine the efficacy Technology Acceptance Model (TAM), it contributes of the ECD system in considering the perceived ease of a theoretical model-based for explaining or anticipates use, perceived usefulness and perceived system quality the factors that cause an individual to accept or reject which substantially contribute to healthcare provider information technology (IT). TAM is proven to be a fit success. In the context of this study, it analysed the model for the healthcare context to predict the attitudes perception on ECD system among the nurses who play towards using the computerized system by investigating an important role in the Malaysian healthcare system. the users’ perceptions of IT. A study by Garavand et al. The computerised documentation is an electronic (2016) concluded that TAM showed validity, reliability, information system used by healthcare practitioners, power and simplicity of IT and additional studies that including nurses, to regularly record clinical information were conducted showed the high ability of the TAM to related to an individual’s health. In the practice setting, demonstrate the technology adoption among staff. this digitalised collection of information is referred to as In this study, two distinct variables were validated; the patient’s electronic health or medical record. This perceived usefulness and perceived ease of use were includes the diagnoses, assessment data, medication exploited. Perceived ease of use refers to the extent or orders, clinical intervention, patient’s medical histories, degree to which the consumer assumes or believes that consultations, care plan, laboratory data and patient the information system is simple to use and easy to use, outcomes. This record is very useful in promoting high whereas perceived usefulness refers to people’s level of delivery of quality care by facilitating the structured belief that using the system would help them achieve communication between nurses and other members better job results and whether or not they will use such of the healthcare team and could give largely positive technology. One external variable is added to study the impact on patient safety (Mehrotra et al., 2016). perception towards the quality of system. Perceived Over the last few decades, many models and theories system quality is defined as a standard of system that had have been developed and tested in order to identify been measured which reflects to its own system’s values variables affecting the acceptance and use of technology and integrity including on its completeness and accuracy provided to end-users. Among them, the Technology of data components. Figure I shows a model consisting of Acceptance Model (TAM) stimulated one of the most two TAM variables, perceived ease of use and perceived active streams of research to predict intention to use the usefulness as prediction variables in addition to the other 6 Nurses’NURSES’ acceptAacceptanceNCE ON ECD IeJSME 2021 15 (2): 5-18 factor, perceived system quality, which has shown its • H2 = Perceived usefulness has a significant and positive importance in influencing the perception of information effect on the perception of nurses on electronic clinical system. Thus, this study developed the hypothesis: documentation. • H1 = Perceived ease of use has a significant and positive • H3 = Perceived system quality has a significant and effect on the perception of nurses on electronic clinical positive effect on the perception of nurses on electronic documentation. clinical documentation. Perceived H1 ease of use Perceived Perception of electronic H2 usefulness clinical documentation Perceived system quality H3 Figure I: Conceptual framework of Perception of Electronic Clinical Documentation Methodology • The hospitals were in the transitional phase from Study setting paper-based documentation to electronically-based documentation This study was conducted in three private hospitals Participants within Klang Valley. The hospitals involved in the study were considered as specialist hospitals and tertiary The target population of participants included all private hospitals. These hospitals had been identified nurses with more than two (2) years working experience and certified nationally by the Malaysian Society for at target hospitals and were experienced in using ECD Quality in Health Care and internationally by the Joint in their clinical practice during the data collection Commission International.