Introduction
The traditional paper-based medical record is rapidly being replaced by modern health information technologies (HITs) to better manage patient information.1 2 Electronic health records (EHRs) can assist healthcare providers in generating, storing and retrieving vital patient information, ranging from medical histories to lab diagnostics, for the provision of high-quality care at different levels.3–5 EHRs are crucial for improving patient safety, quality of care and the efficiency of patient care delivery, as well as reducing medical errors and healthcare costs.6 7 Menachemi and Collum further note that the system assists healthcare providers to easily share and access patient data at any point of care, resulting in enhanced delivery of care.8 These benefits have been associated with positive perceptions of the EHRs by healthcare professionals.9 10 Similarly, patients have largely reported positive perceptions and high satisfaction with the use of EHRs mainly due to benefits related to access to personal health records and acting as an educational resource despite having few concerns, such as disruption of doctor–patient interaction and privacy issues11 12 Thus, the EHR has emerged as an important tool for enhancing efficiency in healthcare processes, facilitating information sharing between healthcare providers themselves and between healthcare providers and their patients, and improving the quality of care as well as patient safety.
Due to these perceived benefits of EHRs in health service provision, the systems are increasingly adopted in various healthcare settings across the world. The countries in the Gulf Cooperation Council (GCC), namely Saudi Arabia, Kuwait, Oman, Qatar, United Arab Emirates (UAE) and Bahrain have also increased their investments in various forms of HITs to improve efficiency and delivery of healthcare services in hospitals and primary care centres.13 For example, the UAE launched a health information system (HIS), known as Wareed in 2011 to link electronic medical records in all public hospitals and clinics across Dubai and the Northern Emirates to improve efficiency in the public healthcare system.14 15 By the end of 2010, Oman had implemented the national repository of EHRs15 while Saudi Arabia committed $1.1 billion between 2008 and 2011 for the development of E-health programme and implementation of various health information tools, including EHRs to improve health and care services as part of its E-health strategy in Saudi Vision 2030.16 Despite these tremendous efforts in EHR adoption, there have also been notable challenges and barriers, such as increased costs during the implementation,17 18 privacy concerns19 and user acceptance.1 20 21 Khoja and colleagues13 noted that although cost/benefit analysis needs to be determined, the increasing demand and misuse of health technologies will most likely increase the overall costs. These challenges are more noticeable in the GCC nations and other developing countries compared with those with advanced economies because they still have less developed infrastructure and governance.22
Several other factors, such as the lack of adequate implementation policies, inadequate staff capabilities and capacity and distrust in the system have also been cited to contribute to the low adoption rates of EHRs and related HITs in the GCC countries.22 23 In relation to healthcare professionals who are the primary users of EHR systems in healthcare settings, their capabilities, including lack of the requisite skills and knowledge to use the systems due to lack of or inadequate training in health applications that discourage their use have been shown to have negative impacts on EHR adoption and use.13 23 Furthermore, healthcare professionals’ perception appears to play a significant role in EHR adoption and use with several theories and models predicting technology acceptance, such as the Technology Acceptance Model postulating that users’ attitude is a significant determinant of acceptance and use of new technology. However, little is known about the perceptions of healthcare professionals on the adoption and use of EHRs in healthcare settings in the GCC context. The objective of this paper is to report the findings from a systematic review of the literature examining the perceptions of healthcare professionals towards the adoption and use of EHRs in order to influence the implementation strategies, training programme and policy development in the GCC region. Although implementation and adoption are often used interchangeably, Murphy24 asserted that these terms differ in that the former is a short-term process of introducing an EHR system while adoption focuses on the long-term success through various strategies, such as providing adequate staff training. Conversely, the concept of use refers to actual utilisation of the EHR systems by the individual users to perform various functions during the process of care provision.25