gms | German Medical Science

Introduction: Numerous studies on technology acceptance and information system usage assess the initial intention to use systems before real-world implementation. However, early success doesn't always translate into long-term use, as the factors driving continued usage can change over time [1]. Thus, longitudinal study designs are desirable. This holds for all health information technologies but particularly for complex technologies such as the implementation of smart workflows throughout a hospital system. The present study aims to compare the factors that influence usage attitudes and behavioural intentions according to the expanded two-stage model of Information System Continuance [2]: Pre-Usage-Stage (t1) and the Pilot Stage (t2). Data in the Pre-Usage-Stage had been measured and modelled in [3]. This study should show the results of t2 and its comparison with t1.

Methods: A longitudinal evaluation study was conducted to assess the implementation of smart workflows designed to automate routine activities and intelligently guide user management in selected processes. The first survey was conducted from May 2021 to September 2021 and the second survey was as an interim assessment following the pilot stage from June 2022 to December 2022. The end-users operated an Android-based mobile device, akin to a smartphone but equipped with an integrated scanner, that captures and integrates patient data directly at the point of care, embodying the principles of intelligent information logistics in a smart hospital. Data was collected from seven general hospitals in Hannover, Lower Saxony, which have a total capacity of 3,400 beds and manage 100,000 cases annually. The questionnaire, comprising 31 closed-ended questions, addressed constructs such as perceived usefulness (PU), effort expectancy (EE), social influence (SI), facilitating conditions (FC), trust (T), self-efficacy (SE), pre- and post-usage attitude (ATT), and behavioural intention (BI) to use at t1 and continuance intention at t2. At t2, after technology implementation, 54 out of 143 staff from the same units as in t1 responded, a 37.8% response rate. It consisted of data from 54 participants (female: 74.0%; male: 26.0%). The median age was 47.0 years and median professional experience was 25.0 years. The occupational group was composed of nurses (74.1%), (medical) technical assistants (20.4%), and others (5.6%). A smaller sample than at t1 (n=310), its demographic mix resembled that of t1.

Results: The following mean values, standard deviations and differences in means were calculated for the variables: Table 1 [Tab. 1].

Discussion and conclusion: All measures taken post-usage were lower than the pre-usage measures, suggesting that it was likely that the users’ perceptions changed due to the exposition and usage of the system. These observations are in line with previous studies [2], [4] that users’ cognitions about IS Usage change over time. The initial negative confirmation may stem from insufficient master data quality, adding extra user effort during the pilot phase. These results will be verified in a larger-scale study after full implementation of the technology in a structural equation model.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.