Download PDF
Appl Clin Inform 2022; 13(01): 148-160
DOI: 10.1055/s-0041-1742217
Research Article

Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature

Consuela C. Yousef
1   Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
3   King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
,
Teresa M. Salgado
4   Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States
,
Ali Farooq
5   Department of Computing, University of Turku, Turku, Finland
,
Keisha Burnett
6   Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Laura E. McClelland
7   Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
,
Laila C. Abu Esba
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
3   King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
8   Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
,
Hani S. Alhamdan
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
9   Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
,
Sahal Khoshhal
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
3   King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
10   Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
,
Ibrahim Aldossary
2   King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
3   King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
11   Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
,
Omar A. Alyas
12   College of Medicine, Royal College of Surgeons in Ireland—Medical University of Bahrain, Kingdom of Bahrain
,
Jonathan P. DeShazo
7   Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance.

Objective The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework.

Methods Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS.

Results There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships.

Conclusion Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.

Keywords

personal health records - secure messaging - UTAUT - eHealth - health care providers

Protection of Human and Animal Subjects

The study was performed in compliance with the Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. All procedures involving human participants were approved by the institutional review boards of King Abdullah International Medical Research Center and Virginia Commonwealth University.




Publication History

Received: 31 July 2021

Accepted: 07 December 2021

Article published online:
09 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27 (03) 759-769
    CrossrefPubMedSearch in Google Scholar
  • 2 Eysenbach G. What is e-health?. J Med Internet Res 2001; 3 (02) E20
    CrossrefPubMedSearch in Google Scholar
  • 3 Meier CA, Fitzgerald MC, Smith JM. eHealth: extending, enhancing, and evolving health care. Annu Rev Biomed Eng 2013; 15 (01) 359-382
    CrossrefPubMedSearch in Google Scholar
  • 4 Gerber T, Olazabal V, Brown K, Pablos-Mendez A. An agenda for action on global e-health. Health Aff (Millwood) 2010; 29 (02) 233-236
    CrossrefPubMedSearch in Google Scholar
  • 5 DeLuca JM, Enmark R. E-health: the changing model of healthcare. Front Health Serv Manage 2000; 17 (01) 3-15
    CrossrefPubMedSearch in Google Scholar
  • 6 Lancaster K, Abuzour A, Khaira M. et al. The use and effects of electronic health tools for patient self-monitoring and reporting of outcomes following medication use: Systematic review. J Med Internet Res 2018; 20 (12) e294
    CrossrefPubMedSearch in Google Scholar
  • 7 Murphy-Abdouch K, Dolezel D, McLeod A. Patient access to personal health information: an analysis of the consumer's perspective. Accessed June 11, 2020 at: https://perspectives.ahima.org/patient-accesstophi/
    PubMed
  • 8 Holmgren AJ, Downing NL, Bates DW. et al. Assessment of electronic health record use between US and non-US health systems. JAMA Intern Med 2021; 181 (02) 251-259
    CrossrefPubMedSearch in Google Scholar
  • 9 Finney Rutten LJ, Agunwamba AA, Greene SM. et al. Enabling patient-centered communication and care through health information technology. J Commun Healthc 2014; 7 (04) 255-261
    CrossrefPubMedSearch in Google Scholar
  • 10 Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: what does the evidence say?. Patient Educ Couns 2017; 100 (01) 50-64
    CrossrefPubMedSearch in Google Scholar
  • 11 Hogan TP, Luger TM, Volkman JE. et al. Patient centeredness in electronic communication: evaluation of patient-to-health care team secure messaging. J Med Internet Res 2018; 20 (03) e82
    CrossrefPubMedSearch in Google Scholar
  • 12 Street Jr RL. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome. Patient Educ Couns 2013; 92 (03) 286-291
    CrossrefPubMedSearch in Google Scholar
  • 13 Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inform 2015; 6 (02) 288-304
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Bouayad L, Ialynytchev A, Padmanabhan B. Patient health record systems scope and functionalities: literature review and future directions. J Med Internet Res 2017; 19 (11) e388
    CrossrefPubMedSearch in Google Scholar
  • 15 Detmer D, Bloomrosen M, Raymond B, Tang P. Integrated personal health records: transformative tools for consumer-centric care. BMC Med Inform Decis Mak 2008; 8: 45
    CrossrefPubMedSearch in Google Scholar
  • 16 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015; 17 (02) e44-e44
    CrossrefPubMedSearch in Google Scholar
  • 17 McAlearney AS, Fareed N, Gaughan A, MacEwan SR, Volney J, Sieck CJ. Empowering patients during hospitalization: perspectives on inpatient portal use. Appl Clin Inform 2019; 10 (01) 103-112
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Kuo A, Dang S. Secure messaging in electronic health records and its impact on diabetes clinical outcomes: a systematic review. Telemed J E Health 2016; 22 (09) 769-777
    CrossrefPubMedSearch in Google Scholar
  • 19 Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. J Am Med Inform Assoc 2013; 20 (03) 519-525
    CrossrefPubMedSearch in Google Scholar
  • 20 Hagedorn PA, Kirkendall ES, Spooner SA, Mohan V. Inpatient communication networks: leveraging secure text-messaging platforms to gain insight into inpatient communication systems. Appl Clin Inform 2019; 10 (03) 471-478
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Chung S, Panattoni L, Chi J, Palaniappan L. Can secure patient-provider messaging improve diabetes care?. Diabetes Care 2017; 40 (10) 1342-1348
    CrossrefPubMedSearch in Google Scholar
  • 22 Sieck CJ, Walker DM, Hefner JL, Volney J, Huerta TR, McAlearney AS. Understanding secure messaging in the inpatient environment: a new avenue for communication and patient engagement. Appl Clin Inform 2018; 9 (04) 860-868
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Alpert JM, Wang S, Bylund CL. et al. Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE). Patient Educ Couns 2021; 104 (06) 1380-1386
    CrossrefPubMedSearch in Google Scholar
  • 24 Chen Y, Tang C, Doung V. et al. “I don't bother with the phone!”: Feeling closer to physician using secure messaging. Accessed December 27, 2021 at: https://pdfs.semanticscholar.org/a589/a6dabf87e6e0042c86422308f9666d061992.pdf
    PubMed
  • 25 Hogan TP, Wakefield B, Nazi KM, Houston TK, Weaver FM. Promoting access through complementary eHealth technologies: recommendations for VA's Home Telehealth and personal health record programs. J Gen Intern Med 2011; 26 (2, suppl 2) 628-635
    CrossrefPubMedSearch in Google Scholar
  • 26 Alpert JM, Markham MJ, Bjarnadottir RI, Bylund CL. Twenty-first century bedside manner: exploring patient-centered communication in secure messaging with cancer patients. J Cancer Educ 2021; 36 (01) 16-24
    CrossrefPubMedSearch in Google Scholar
  • 27 Alshahrani A, Stewart D, MacLure K. A systematic review of the adoption and acceptance of eHealth in Saudi Arabia: Views of multiple stakeholders. Int J Med Inform 2019; 128: 7-17
    CrossrefPubMedSearch in Google Scholar
  • 28 National Transformation Program. Published 2018. Accessed December 24, 2019 at: https://vision2030.gov.sa/sites/default/files/attachments/NTPEnglishPublicDocument_2810.pdf
    PubMed
  • 29 AlBar AM, Hoque MR. Patient acceptance of e-health services in Saudi Arabia: an integrative perspective. Telemed J E Health 2019; 25 (09) 847-852
    CrossrefPubMedSearch in Google Scholar
  • 30 Center Strategy. National Health Information Center. Published 2021. Accessed October 6, 2021 at: https://nhic.gov.sa/en/AboutUs/Pages/StrategicObjectives.aspx
    PubMed
  • 31 Alharbi MA. The status quo of health information technology and health information management efficiency in saudi arabia: a narrative review. International Journal of Health Research and Innovation. 2018; 6 (01) 11-23
    PubMedSearch in Google Scholar
  • 32 AlSadrah SA. Electronic medical records and health care promotion in Saudi Arabia. Saudi Med J 2020; 41 (06) 583-589
    CrossrefPubMedSearch in Google Scholar
  • 33 Alsulame K, Khalifa M, Househ M. E-Health status in Saudi Arabia: a review of current literature. Health Policy Technol 2016; 5 (02) 204-210
    CrossrefPubMedSearch in Google Scholar
  • 34 Alsahafi YA, Gay V, Khwaji AA. Factors affecting the acceptance of integrated electronic personal health records in Saudi Arabia: the impact of e-health literacy. Health Inf Manag 2020;
    CrossrefPubMedSearch in Google Scholar
  • 35 Alhammad OS, McKibbon A. Assessing outpatients' attitudes and expectations towards electronic personal health records (ePHRs) systems in secondary and tertiary hospitals in Riyadh, Saudi Arabia. J Health Inform Dev Ctries 2021;15(02):doi: https://orcid.org/0000-0003-3997-2264
    PubMed
  • 36 Al Sahan A, Saddik B. Al-Sahan A MSc (HI), Saddik B PhD, MPH. Perceived challenges for adopting the Personal Health Record (PHR) at Ministry of National Guard Health Affairs (MNGHA)- Riyadh. Online J Public Health Inform 2016; 8 (03) e205
    PubMedSearch in Google Scholar
  • 37 Belcher T, Vess J, Johnson E. Using patient portal messaging to improve glycemic control in adult patients with diabetes in Saudi Arabia. Accessed December 27, 2021 at: https://www.himss.org/resources/using-patient-portal-messaging-improve-glycemic-control-adult-patients-diabetes-saudi
    PubMed
  • 38 Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: toward a unified view. Manage Inf Syst Q 2003; 27 (03) 425-478
    CrossrefPubMedSearch in Google Scholar
  • 39 Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: A comparison of two theoretical models. Manage Sci 1989; 35 (08) 982-1003
    CrossrefPubMedSearch in Google Scholar
  • 40 Abd-Alrazaq A, Bewick BM, Farragher T, Gardner P. Factors affecting patients' use of electronic personal health records in England: cross-sectional study. J Med Internet Res 2019; 21 (07) e12373
    CrossrefPubMedSearch in Google Scholar
  • 41 Tavares J, Oliveira T. Electronic health record patient portal adoption by health care consumers: an acceptance model and survey. J Med Internet Res 2016; 18 (03) e49
    CrossrefPubMedSearch in Google Scholar
  • 42 Tripathi S. Moderating effects of age and experience on the factors influencing the actual usage of cloud computing. Journal of International Technology and Information Management. 2018; 27 (02) 121-15
    CrossrefPubMedSearch in Google Scholar
  • 43 Carlton EL, Holsinger Jr. JW, Anunobi N. Physician engagement with health information technology: Implications for practice and professionalism. International Journal of Computers in Clinical Practice. 2016; 1 (02) 51-73
    CrossrefPubMedSearch in Google Scholar
  • 44 Venkatesh V, Sykes TA, Zhang X. “Just what the doctor ordered”: A revised UTAUT for EMR system adoption and use by doctors. In: 2011 44th Hawaii International Conference on System Sciences; 2011:1–10; Hawai, United States
    PubMed
  • 45 Li J, Talaei-Khoei A, Seale H, Ray P, Macintyre CR. Health care provider adoption of ehealth: systematic literature review. Interact J Med Res 2013; 2 (01) e7
    CrossrefPubMedSearch in Google Scholar
  • 46 Kujala S, Hörhammer I, Kaipio J, Heponiemi T. Health professionals' expectations of a national patient portal for self-management. Int J Med Inform 2018; 117: 82-87
    CrossrefPubMedSearch in Google Scholar
  • 47 Wiljer D, Urowitz S, Apatu E. et al; Canadian Committee for Patient Accessible Health Records. Patient accessible electronic health records: exploring recommendations for successful implementation strategies. J Med Internet Res 2008; 10 (04) e34
    CrossrefPubMedSearch in Google Scholar
  • 48 MNGHA Organization Profile. Ministry of National Guard -Health Affairs. Published 2018. Accessed September 6, 2019 at: https://ngha.med.sa/English/AboutNGHA/Pages/profile.aspx
    PubMed
  • 49 Yousef CC, Thomas A, Alenazi AO. et al. Adoption of a personal health record in the digital age: cross-sectional study. J Med Internet Res 2020; 22 (10) e22913
    CrossrefPubMedSearch in Google Scholar
  • 50 MNGHA Care Mobile Application. Published 2020. Accessed June 29, 2020 at: https://ngha.med.sa/English/eServices/Pages/patientportall.aspx
    PubMed
  • 51 Kline RB. Principles and Practice of Structural Equation Modeling. 4th ed.. New York, NY: Guilford publications; 2015
    Search in Google Scholar
  • 52 Haun JN, Hathaway W, Chavez M. et al. Clinical practice informs secure messaging benefits and best practices. Appl Clin Inform 2017; 8 (04) 1003-1011
    Thieme ConnectPubMedSearch in Google Scholar
  • 53 Chung M-H, Ho C-H, Wen H-C. Predicting intentions of nurses to adopt patient personal health records: a structural equation modeling approach. Comput Methods Programs Biomed 2016; 136: 45-53
    CrossrefPubMedSearch in Google Scholar
  • 54 Hennemann S, Beutel ME, Zwerenz R. Ready for eHealth? Health professionals' acceptance and adoption of eHealth interventions in inpatient routine care. J Health Commun 2017; 22 (03) 274-284
    CrossrefPubMedSearch in Google Scholar
  • 55 Hoogenbosch B, Postma J, de Man-van Ginkel JM, Tiemessen NA, van Delden JJ, van Os-Medendorp H. Use and the users of a patient portal: Cross-sectional study. J Med Internet Res 2018; 20 (09) e262
    CrossrefPubMedSearch in Google Scholar
  • 56 Khaneghah PA, Miguel-Cruz A, Bentley P, Liu L, Stroulia E, Ferguson-Pell M. Users' attitudes towards personal health records. Appl Clin Inform 2016; 7 (02) 573-586
    Thieme ConnectPubMedSearch in Google Scholar
  • 57 Free Online Survey Software and Tools. Accessed October 8, 2021 at: https://www.questionpro.com/
    PubMed
  • 58 Yousef CC, Salgado TM, Farooq A. et al. Health care providers' acceptance of a personal health record: cross-sectional study. J Med Internet Res 2021; 23 (10) e31582
    CrossrefPubMedSearch in Google Scholar
  • 59 Venkatesh V, Thong JYL, Xu X. Consumer acceptance and use of information technology: Extending the unified theory of acceptance and use of technology. Manage Inf Syst Q 2012; 36 (01) 157-178
    CrossrefPubMedSearch in Google Scholar
  • 60 Wu J, Du H. Toward a better understanding of behavioral intention and system usage constructs. Eur J Inf Syst 2012; 21 (06) 680-698
    CrossrefPubMedSearch in Google Scholar
  • 61 Williams MD, Rana NP, Dwivedi YK. The unified theory of acceptance and use of technology (UTAUT): A literature review. J Enterp Inf Manag 2015; 28 (03) 443-488
    CrossrefPubMedSearch in Google Scholar
  • 62 Balau M. Exploring the link between intention and behavior in consumer research. EIRP Proceedings. Accessed December 27, 2021 at: http://proceedings.univ-danubius.ro/index.php/eirp/article/view/1864/2200
    PubMed
  • 63 Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012; 81 (11) 746-760
    CrossrefPubMedSearch in Google Scholar
  • 64 Yousef CC, Salgado TM, Farooq A. et al. Predicting Patients' Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis. JMIR Med Inform 2021; 9 (08) e30214
    CrossrefPubMedSearch in Google Scholar
  • 65 IBM Corporation. IBM SPSS Statistics for Windows. Accessed December 27, 2021 at: https://www.ibm.com/in-en/analytics/spss-statistics-software
    PubMed
  • 66 Ringle CM, Wende S, Becker JM. SmartPLS 3.0. Hamburg, Germany. Accessed December 27, 2021 at: https://www.smartpls.com/
    PubMed
  • 67 Tavares J, Oliveira T. Electronic health record portal adoption: a cross country analysis. BMC Med Inform Decis Mak 2017; 17 (01) 97
    CrossrefPubMedSearch in Google Scholar
  • 68 Ringle CM, Sarstedt M, Straub DW. Editor's comments: a critical look at the use of PLS-SEM in” MIS Quarterly”. MIS Quarterly 2012; 36 (01) iii-xiv
    CrossrefPubMedSearch in Google Scholar
  • 69 Farooq A, Ahmad F, Khadam N, Lorenz B, Isoaho J. The Impact of Perceived Security on Intention to use E-Learning Among Students. In: 2020 IEEE 20th International Conference on Advanced Learning Technologies (ICALT);2020:360–364; Tartu, Estonia
    PubMed
  • 70 Farooq A, Laato S, Islam AKMN, Isoaho J. Understanding the impact of information sources on COVID-19 related preventive measures in Finland. Technol Soc 2021; 65: 101573
    CrossrefPubMedSearch in Google Scholar
  • 71 Hair JF, Sarstedt M, Hopkins L, Kuppelwieser VG. Partial least squares structural equation modeling (PLS-SEM): an emerging tool in business research. Eur Bus Rev 2014; 26 (02) 106-121
    CrossrefPubMedSearch in Google Scholar
  • 72 Bennani A, Belalia M, Oumlil R. As a human factor, the attitude of healthcare practitioners is the primary step for the e-health: first outcome of an ongoing study in Morocco. Commun IBIMA. 2008; 3: 28
    PubMedSearch in Google Scholar
  • 73 Djamasbi S, Fruhling A, Loiacono E. The influence of affect, attitude and usefulness in the acceptance of telemedicine systems. J Inf Technol Theory Appl 2009; 10 (01) 41-58
    PubMedSearch in Google Scholar
  • 74 Nazi KM. The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res 2013; 15 (04) e70
    CrossrefPubMedSearch in Google Scholar
  • 75 Ibrahim S, Donelle L, Regan S, Sidani S. Predicting registered nurses' behavioural intention to use electronic documentation system in home care: application of an adapted unified theory of acceptance and use of technology model. Nursing Leadership 2019; 32 (02) 48-70
    CrossrefPubMedSearch in Google Scholar
  • 76 Alanazi B, Butler-Henderson K, Alanazi MR. Factors influencing healthcare professionals' perception towards EHR/EMR systems in Gulf Cooperation Council Countries: a systematic review. Oman Med J 2020; 35 (06) e192
    CrossrefPubMedSearch in Google Scholar
  • 77 Abd-Alrazaq A, Alalwan AA, McMillan B, Bewick BM, Househ M, Al-Zyadat AT. Patients' adoption of electronic personal health records in england: secondary data analysis. J Med Internet Res 2020; 22 (10) e17499
    CrossrefPubMedSearch in Google Scholar
  • 78 Park HS, Kim KI, Soh JY, Hyun YH, Jang SK, Lee S, Hwang GY, Kim HS. Factors influencing acceptance of personal health record apps for workplace health promotion: cross-sectional questionnaire study. JMIR Mhealth Uhealth 2020; 8 (06) e16723
    CrossrefPubMedSearch in Google Scholar
  • 79 Abd-Alrazaq AAE. Factors affecting patients' use of electronic personal health records. University of Leeds 2018
    PubMedSearch in Google Scholar
  • 80 Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017; 104: 84-96
    CrossrefPubMedSearch in Google Scholar
  • 81 Dwivedi YK, Rana NP, Jeyaraj A, Clement M, Williams MD. Re-examining the unified theory of acceptance and use of technology (UTAUT): Towards a revised theoretical model. Inf Syst Front 2019; 21 (03) 719-734
    CrossrefPubMedSearch in Google Scholar
  • 82 Hassounah M, Raheel H, Alhefzi M. Digital response during the COVID-19 pandemic in Saudi Arabia. J Med Internet Res 2020; 22 (09) e19338
    CrossrefPubMedSearch in Google Scholar
  • 83 Gagnon M-P, Payne-Gagnon J, Breton E. et al. Adoption of electronic personal health records in Canada: perceptions of stakeholders. Int J Health Policy Manag 2016; 5 (07) 425-433
    CrossrefPubMedSearch in Google Scholar
  • 84 Lluch M. Healthcare professionals' organisational barriers to health information technologies-a literature review. Int J Med Inform 2011; 80 (12) 849-862
    CrossrefPubMedSearch in Google Scholar
  • 85 Feinberg J, Shaw S, Kashyap N. et al. Evaluating the impact of a new smartphone texting tool on patient care in obstetrics, an emergent healthcare setting. Appl Clin Inform 2019; 10 (05) 879-887
    Thieme ConnectPubMedSearch in Google Scholar
  • 86 Tsega S, Kalra A, Sevilla CT, Cho HJ. A bottom-up approach to encouraging sustained user adoption of a secure text messaging application. Appl Clin Inform 2019; 10 (02) 326-330
    Thieme ConnectPubMedSearch in Google Scholar
  • 87 Al Knawy B, Adil M, Crooks G. et al. The Riyadh Declaration: the role of digital health in fighting pandemics. Lancet 2020; 396 (10262): 1537-1539
    CrossrefPubMedSearch in Google Scholar