Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey
- Affiliations of the authors at the University of Hong Kong, Hong Kong, China: Department of Community Medicine, Medical and Health Research Network (GML); Department of Statistics and Actuarial Sciences (PLHY); Department of Community Medicine (IOLW, JMJ, KYKT)
- Correspondence and reprints: Gabriel M. Leung, MD, MPH, Department of Community Medicine, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong; e-mail: <gmleung{at}hku.hk>
- Received 14 August 2002
- Accepted 28 October 2002
Abstract
Objective Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation.
Design and Measurements A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation.
Results Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and “push” vs “pull” factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive.
Conclusion This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems.
Footnotes
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The study received financial support from a “low budget-high impact” grant of the University of Hong Kong. We thank Marie Chi for expert secretarial assistance in the preparation of the manuscript.
