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network with shared data storage locations
(Fraunhofer Institut, 2005). This service oriented
architecture (SOA) provides services: the primary
systems (e.g., clinical information systems or
practice information system) of medical institutions
can invoke them to communicate with other care
providers and maintain, review or share medical data
objects. A local component, called “Connector,”
encapsulates all local services, as encryption or card
access and establishes a secure virtual private
network (VPN) connection to the central services if
needed (gematik, 2008a).
So far a number of different basic offline health
services, such as electronic prescription, emergency
data, and insurance basic data service, have been
tested in seven regions to verify the functions of the
technical infrastructure deployed. In the long term,
further services like electronic health records,
electronic physician letters, and electronic drug
documentation should be offered online via the
infrastructure. The infrastructure will be kept open
for the development of commercial value-added
services (Bernnat, 2006). Evaluation of the online
functionality of electronic health services will be
started with around 200 care providers in the test
region, involving about 100,000 citizens with health
insurance.
2 DISPUTE OVER THE EHC
Previous surveys have shown that a vast majority of
physicians rejects electronic services offered by the
National TI (Techniker Krankenkasse, 2009, Oliver
Kalthoff et al., 2008). Numerous campaigns have
been started by medical associations and politicians,
calling for a moratorium of the eHC project (Tuffs,
2008). The main reasons for rejection, as indicated
by the objectors, are safety concerns about central
storage of patients’ medical data as well as the
unsatisfactory performance during the offline testing
of services and infrastructure (Oliver Kalthoff et al.,
2008). Moreover, testing and introduction of the
eHC have been delayed many times: although the
initial introduction date was set for 2006, the testing
has still not been completed in 2009. The date of the
final introduction is not yet clear.
In order to get a clear picture of the
characteristics of physicians in the ambulant sectors,
we analyzed the characteristics in depth of
physicians who, in contrast to care providers in
hospitals, decide independent of management on the
adoption of the TI and its services. Important fields
of medical work, intended to be improved by the
telematics, were the focus of the research. The goal
was to conclude whether rejection and support of the
telematics correlate with other aspects that are
important in daily work in ambulatory practices.
Therefore, the usage intention was measured directly
to get a clear picture of the general adoption
preferences. To scrutinize the publicly dispersed
criteria leading to rejection, we grouped physicians
according to their behavioral intention. The resulting
clusters were then analyzed in terms of the
remaining criteria to find out which characteristics
were common for the different adopter groups.
Consolidated findings, of the survey thus enabled
predictions about general attitude, working
characteristics, and equipment of physicians,
derivable from the usage intentions.
3 METHODOLOGY
3.1 Survey Design
The survey was developed based on the Unified
Theory of Acceptance and Use of Technology
(UTAUT) to determine the usage intention for
electronic health services deployed via the national
TI for the support of ambulatory care (Venkatesh et
al., 2003). Based on medical goals documented by
leading institutions of the healthcare system and the
German government (Bundesrepublik Deutschland,
1988), we further asked for certain important
healthcare aspects, such as security concerns
(Sunyaev et al., 2009), treatment and administration
standards, patient involvement, and inter-
institutional communication (Hoppe and Richter-
Reichhelm, 2000, Haux, 2005), before posing the
questions about telematics and EHS. The question
sequence was designed to ensure minimum
influence of the public opinion on the answer
patterns not directly related to the telematics.
The questionnaire was named “Survey on IT
diffusion in ambulatory health care.” We
investigated the state of conventional Information
Technology in ambulatory practices and its usage by
physicians as well. The goal was to gain information
on the status quo of the testing region concerning the
aspects mentioned. Further, we were keen to find the
medical domain-related characteristics of medical
personnel and practices to be predictable when
measuring usage intention based on the UTAUT
model.
DO GERMAN PHYSICIANS WANT ELECTRONIC HEALTH SERVICES? - A Characterization of Potential Adopters
and Rejecters in German Ambulatory Care
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