Exploring user acceptance of an e-hospital service: An empirical study in Taiwan

doi:10.1016/j.csi.2014.08.004

Computer Standards & Interfaces

Volume 38, February 2015, Pages 35-43

https://doi.org/10.1016/j.csi.2014.08.004 Get rights and content

Abstract

The web-based appointment system (WAS) is considered one of the major Internet services provided by e-hospitals. Because of the very high adoption rate of WAS in the public medical centers in Taiwan, this research investigates the current status of its implementation and examines the factors affecting the user acceptance of WAS by integrating the Technology Acceptance Model (TAM) with the constructs of service quality. Further, this study proposes a research framework that delineates the user acceptance of WAS, which is verified via an empirical survey. This article is concluded with the managerial implications and suggestions.

Introduction

The success and prevalence of the Internet has made web-based systems become an important medium in connecting service/product providers with their customers. It also created a new arena for firms in various industries. The healthcare industry is not exempt from this new arena; hospitals are eager to develop and implement web-based information systems. Therefore, every health-care institution's current, top priority is to reduce the workload of staff and improve efficiency and service quality though the utilization of information technology and the Internet [7]. In order to gain a competitive edge, hospitals are developing and implementing web-based e-hospital systems that will enhance clinical service quality, promote patient loyalty, reduce operation cost, and increase the efficiency of hospital management [18]. E-hospital systems provide various e-hospital services, such as remote monitoring of patients, clinical information collection and processing and web-based appointment systems. The web-based appointment system (WAS) is considered the as paramount of all of these new Internet services provided by e-hospitals.

WAS not only provides a convenient channel for patients to remotely make clinical appointments on the Internet, but also offers rich data warehousing for doctors to retrieve a patient's medical records, which are useful and beneficial for tracing a patience's recovery or making cross-department consultations. In comparison to other e-hospital implementations, WAS is widely employed by medical centers. The e-hospital systems such as WAS are evolving toward user-centricity, where the patients are able to control the granularity of healthcare information disclosed to the third party, by specifying the content of the health information and to which healthcare provider can the information can be disclosed, and the purpose of processing the information, etc. [15]. Therefore, it is a crucial issue for hospitals to explore the acceptance of WAS from the patient's viewpoints. However, prior studies which discuss the user acceptance of WAS are very limited.

Since WAS is the pioneer of the e-hospital business, the health-care industry and the academic world pay high attention to the acceptance of WAS. Therefore, one of the research objectives of this study is to reveal the current status of WAS implementation in Taiwan. To facilitate the exploration of the acceptance of new information technologies or systems, the Technology Acceptance Model (TAM), which helps to explain the intentions and behavior of users, will be implemented in the research of this study. The exclusive use of the TAM in this study is not enough to fully disclose users' acceptance, since WAS is not only an information system, but also an information-intensive service; the service quality may also influence the acceptance of WAS. Therefore, this study will also aim to probe into the factors affecting the user acceptance of WAS by integrating the TAM with the constructs of service quality. Moreover, this study intends to propose a research framework that will delineate the user acceptance of WAS.

Thereafter, an empirical survey will be conducted in a medical center in Taiwan to verify the proposed framework. More specifically, this research will test the following hypotheses in order to derive useful and meaningful findings and conclusions:

1.
The impact of user experience, web site quality and service quality on perceived ease of use;
2.
The impact of user experience, web site quality, service quality and perceived ease of use on perceived usefulness;
3.
The impact of perceived ease of use and perceived usefulness on willingness of use of online registration.

Section snippets

Web services in hospitals

To understand WAS in Taiwan, a survey conducted by Yang [67] randomly sampled information service contents from 14 of 17 medical centers and 44 of 62 regional hospitals. The result of the survey showed that medical centers were more eager to implement online registration services, such as online registration, clinical department suggestion, and outpatient service time schedules, than regional hospitals. For example, 92.9% of medical centers provided online registration in comparison to only

Research framework

Although there have been many prior research studies that have applied TAM literature to study “perceived usefulness”, “perceived ease of use”, and “willingness of use”, and there have also been some studies that have referred to user experience and Internet quality, however, there are only few papers that focus on service quality. Furthermore, of those service quality studies, practical studies that integrate “perceived ease of use” and “perceived usefulness” as external influential factors

Research findings

Since WAS is the pilot trial of the e-hospital, the health-care industry and the academic pay high attention to the acceptance of WAS. WAS is not only an information system but also an information-intensive service. Only the TAM fails to fully disclose the acceptance of WAS. Therefore, this study integrated the TAM with the constructs of service quality in order to explore this issue.

The most interesting finding in this study was that service quality is not a significant variable in the

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Ministry of Health and Family Welfare (MOFHW), under the Digital India project (e-Governance), started a Computerized Online Registration System (CORS) portal in the year 2015, to get online appointments, lab reports and blood availability in any government hospital [3]. Online registrations have previously reported an increase in job efficiency in hospitals [4] and satisfaction levels of patients in other western countries [5,6]. The online appointment system of other countries is different from India as there is a provision of time scheduling in those systems.
In 2015 the Government of India started a Computerized Online Registration System (CORS) for scheduling online appointments. This study was conducted to assess whether the introduction of CORS had any impact on patient satisfaction and patient waiting time for outpatient registration. A study comprising 50 online registered patients and 70 walk-in registered patients was conducted at the adult outpatient departments registration windows (Internal Medicine and General Surgery) of a tertiary level hospital. A pre-tested interview schedule was used to capture the satisfaction levels (%), waiting time (in minutes) and their associated factors in both group of patients.
The Median waiting time for walk-in registered patients was approximately four times (60 min, IQR (30–90)) as compared to the online registered patients (15 min, IQR (10–30)) (p = 0.000). The satisfaction level among the online registered patients (90%, 95% CI (83–97)) was three times higher than the walk-in registered patients (29%, 95% CI (18–40)). The online registered patients were ten times more likely to be satisfied as compared to the walk-in registered patients (Adjusted Odds Ratio 9.8, 95% CI (2.2–43.5)). . Additionally, for every 1% increase in the waiting time at the online registration window (>30 min) the satisfaction decreased by 3% (-3.2%). Hence, the study showed that the CORS improved the user experience by reducing the waiting time and increasing the satisfaction levels at the registration window.
Public Abstract: Online appointment for OPD consultation results in less waiting time at the registration counters of tertiary care public hospitals. If you do not have smartphones, use the phones of your family members or neighbours. If you don't know how to operate the phones, seek help from your family and friends. This study shows, that those who had these problems were still able to register online by seeking help.
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E-appointment systems are useful for patients to plan and organize their medical appointments online. Managing appointments in healthcare organizations and ambulatory care settings is a difficult process and one frequent challenge that several healthcare professionals have to overcome is related to non-attendance. Findings from previous surveys indicate that many physicians are willing to use these systems and patients would be probably to book an online appointment with their health care provider, if the e-appointment system was available. There is a lack of empirical studies that have examined the adoption, user acceptance, and effectiveness of e-appointment systems in private care services. The purpose of this article was the application of the MUSA (MUlticriteria Satisfaction Analysis) method to measure the extent of users’ satisfaction of an e-appointment system of a Greek state hospital in Thessaloniki and to provide useful data to the administrators in order to be able to make better decisions and determine which characteristics of the service need to be improved.
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View full text

Exploring user acceptance of an e-hospital service: An empirical study in Taiwan

Abstract

Introduction

Section snippets

Web services in hospitals

Research framework

Research findings

Int. J. Man Mach. Stud.

Inf. Manag.

Inf. Manag.

Resuscitation

Perceived usefulness, ease of use, and usage of information technology: a replication

MIS Q.

Understanding Attitudes and Predicting Social Behavior

From intention to actions: a theory of planned behavior

Evaluating service encounters: the effects of physical surroundings and employee responses

J. Mark.

A proposal to assess the service quality of online travel agencies: an exploratory study

J. Prof. Serv. Mark.

Classifying web metrics using the web quality model

Online Inf. Rev.

An assessment of technology-based service encounters and network security on the e-health care systems of medical centers in Taiwan

BMC Health Serv. Res.

An empirical assessment of modified technology acceptance model

J. Manag. Inf. Syst.

On the use, usefulness and ease of use of structural equation modeling in MIS research: a note of caution

MIS Q.

Study on the Influence of the Use of Hospital Web Sites of the General Public on Their Behavior for Taking Medical Treatment

A Technology Acceptance Model for Empirically Testing New End-user Information Systems: Theory and Results

Perceived usefulness, perceived ease of use, and user acceptance of information technology

MIS Q.

Information systems success: the quest for the dependent variable

Inf. Syst. Res.

Towards a cross-context identity management framework in e-health

Online Inf. Rev.

The Psychology of Attitudes

User adaptation and infusion of information systems

J. Comput. Inf. Syst.

Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research

An empirical examination of application frameworks success based on technology acceptance model

J. Syst. Softw.

Multivariate Data Analysis

Expert: Hospital Web Sites Require ‘Sophisticated Expectations’

Modeling intention to use novel mobile peer-to-peer services

Int. J. Econ. Bus.

Hospital chooses SaaS for web performance

Health Manag. Technol.

Testing the determinants of microcomputer usage via a structural equation model

J. Manag. Inf. Syst.

Utilizing the technology acceptance model to assess the employee adoption of information systems security measures

J. Int. Technol. Inf. Manag.

Quality Control Handbook

The application of electronic computer to factor analysis

Educ. Psychol. Meas.

An index of factorial simplicity

Psychometrika

Evaluating electronic referrals for specialty care at a public hospital

J. Gen. Intern. Med.

Social networking service: motivation, pleasure, and behavioral intention to use

J. Comput. Inf. Syst.