Going digital in Germany: An exploration of physicians' attitudes towards the introduction of electronic prescriptions - A mixed methods approach

Alexander Graf; Leonard Fehring; Maike Henningsen; Maximillian Zinner

doi:10.1016/j.ijmedinf.2023.105063

Going digital in Germany: An exploration of physicians' attitudes towards the introduction of electronic prescriptions - A mixed methods approach

Int J Med Inform. 2023 Jun:174:105063. doi: 10.1016/j.ijmedinf.2023.105063. Epub 2023 Apr 3.

Authors

Alexander Graf¹, Leonard Fehring², Maike Henningsen¹, Maximillian Zinner³

Affiliations

¹ Witten/Herdecke University, School of Medicine, Faculty of Health, Alfred Herrhausen-Strasse 50, 58448 Witten, Germany.
² Witten/Herdecke University, School of Medicine, Faculty of Health, Alfred Herrhausen-Strasse 50, 58448 Witten, Germany; Medizinische Klinik 2, Helios Universitätsklinikum, 42283 Wuppertal, Germany.
³ Witten/Herdecke University, School of Medicine, Faculty of Health, Alfred Herrhausen-Strasse 50, 58448 Witten, Germany. Electronic address: Maximillian.Zinner@uni-wh.de.

PMID: 37028259
DOI: 10.1016/j.ijmedinf.2023.105063

Abstract

Purpose: Digitalization of medical prescriptions is a core element for the digitalization of healthcare. While some countries have introduced electronic prescriptions over 20 years ago and nearly reached 100 % penetration, physicians in Germany have only been able to use electronic prescriptions since mid-2021 and currently only 0.1 % of prescriptions are transmitted electronically. This study investigates German physicians' viewpoint towards electronic prescriptions as a potential reason for the low penetration and investigates levers to drive adoption.

Basic procedures: We conducted a two-stage sequential mixed methods study consisting of semi-structured interviews followed by an online survey among 1136 physicians testing the main dimensions of the Unified Theory of Acceptance and Use of Technology model.

Main findings: Our initial interviews suggested that there was a high technology acceptance by physicians, but due to technical barriers, they were not able to use the system, explaining the low penetration. However, with the larger sample size of the survey, we identified, that while physicians see barriers for introducing electronic prescriptions, such as unclear cost reimbursement or lack of time to deal with the implementation, the majority believes these can be overcome within twelve months. Furthermore, we found that only one third of physicians is in favor of replacing paper-based prescriptions with electronic prescriptions and most physicians considers it unlikely that they will issue more than half of their prescriptions electronically within the next twelve month. Additionally, respondents perceived limited usefulness and expect high effort for using electronic prescriptions.

Principal conclusion: Low electronic prescription penetration in Germany seems to be driven by low technology acceptance, not technical barriers. This can be linked to low perceived usefulness, high effort expectancy and low perceived patient demand. Improving technical stability, system functionality and increasing physicians' level of information were seen as main levers to drive electronic prescription adoption.

Keywords: Adoption; Electronic prescribing; Healthcare professionals; Healthcare systems; Technology acceptance; UTAUT.

MeSH terms

Attitude of Health Personnel
Attitude to Computers
Electronic Prescribing*
Humans
Physicians*
Surveys and Questionnaires