Understanding physicians' adoption intentions to use Electronic Health Record (EHR) systems in developing countries: an extended TRAM approach

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Abstract
Purpose: The success of an Electronic Health Record (EHR) system is determined by the numerous facilitators and obstacles that influence physicians' intentions toward using these technologies. This study examines physicians' intentions to use EHR by applying the extended technology readiness and acceptance model (TRAM) factors, the result demonstrability, colleagues' opinions, perception of external control, and organizational support.Design/methodology/approach: Convenience sampling was used to collect data from physicians in Egypt (n = 520). To evaluate the model's hypotheses, this study used the partial least squares structural equation modeling (PLS-SEM) method with WarpPLS.7.Findings: The results revealed that positive TR factors (innovativeness and optimism) positively affect perceived usefulness and ease of use, while negative TR factors (discomfort and insecurity) negatively impact perceived usefulness and ease of use. Furthermore, the result demonstrability and colleagues' opinions positively influence perceived usefulness, while the perception of external control and organizational support positively influence perceived ease of use. In addition, significant relationships between perceived ease of use and usefulness and adoption intention were identified.Originality/value: This is the first study to apply the TRAM to understand physicians' adoption intentions to use EHR systems. Moreover, this study determined the different roles of positive and negative TR affecting physicians' cognition regarding using EHR systems.

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