Table 4.
Mapping of metric areas to clinical adoption framework.
| Level | Dimension | Category | Metric area | Typea | Papers (reference number) |
Total number of metrics |
| Meso | People | Individuals and groups | (Determined by type of respondent survey is administered to) | All | 0 | |
| Personal characteristics | Age | B | 23, 26, 28, 29, 31, 32, 33, 36, 39 | 9 | ||
| Gender | B | 22, 23, 24, 26, 28, 29, 30, 32, 33, 35, 36 | 11 | |||
| Race and ethnic background | B | 22 | 1 | |||
| Income | B | 28 | 1 | |||
| Active in general practice and status | B | 35 | 2 | |||
| Graduation year and years of practice | B | 22, 24, 26, 34, 35, 36 | 6 | |||
| Specialty | B | 22, 23, 26, 28, 33, 34, 35, 36, 37, 38, 39 | 11 | |||
| Computer skills and literacy | B | 23, 26, 30, 31, 34, 36 | 9 | |||
| First to have new tests or treatments (general practice) | O | 36 | 1 | |||
| Personal expectations | Comparison between paper based and electronic | I | 27 | 1 | ||
| Feelings toward practice in general | O | 35, 36 | 8 | |||
| Protecting physicians from personal liability for record tampering by external parties | I | 22 | 1 | |||
| Roles and responsibilities | 0 | |||||
| Organization | Strategy | Actively improving quality (general practice) | O | 36 | 1 | |
| Local physician champion | O | 38 | 1 | |||
| Physician recruitment | I | 25 | 1 | |||
| Culture | Bad previous experience with an electronic record system | O | 27 | 1 | ||
| Attitude toward the electronic record system | I | 22, 24, 25, 26, 27, 29 | 4 | |||
| Physician and staff resistance | O | 36, 37 | 9 | |||
| Isolation from colleagues (general practice) | O | 35, 36 | 2 | |||
| Innovative staff (general practice) | O | 36 | 2 | |||
| Information and infrastructure | Ability to interface and integrate with existing practice systems | O | 21, 25, 27, 39 | 6 | ||
| Technical limits | O | 36 | 1 | |||
| Use of other clinical information technology | O | 25, 37, 38 | 4 | |||
| Structure and processes | Practice size (number of staff) | B | 21, 22, 25, 26, 27, 28, 29, 30, 33, 34, 35, 36, 37, 38, 39 | 18 | ||
| Practice size (number of patients) | B | 24, 29, 30, 35, 36 | 5 | |||
| Practice size (number of offices) | B | 38 | 1 | |||
| Time spent caring for patients (hours) | B | 24, 26, 28 | 3 | |||
| Practice type (eg, group) | B | 26, 28, 33 | 3 | |||
| Remuneration patterns | B | 26, 28 | 2 | |||
| Practice setting (eg, hospital or medical center) | B | 22, 37 | 2 | |||
| Type of office | B | 23, 38 | 4 | |||
| Patient population | B | 38 | 2 | |||
| Practice location | B | 22, 29, 33, 36, 37, 38 | 7 | |||
| Communication with general practice business suppliers | O | 30 | 1 | |||
| Return on value | Business expansion | I | 30 | 1 | ||
| Expense of implementation | O | 21, 22, 25, 26, 27, 28, 29, 33, 36, 37, 38 | 13 | |||
| Maintenance costs | O | 21, 27, 26, 29, 33, 36 | 7 | |||
| Expected return on investment | I | 22, 25, 27, 33, 34, 38, 39 | 7 | |||
| Implementation | Stage | Use status | B | 21, 22, 25, 26, 27, 29, 32, 33, 34, 35, 36, 37, 38, 39 | 16 | |
| Future intention to use | B | 21, 22, 23, 27, 33, 34, 37, 38, 39 | 12 | |||
| Project | System development or selection | O | 21, 22, 25, 27 | 5 | ||
| Time costs associated with computerization | I | 21, 25, 26, 28, 33, 36 | 7 | |||
| Loss of productivity during transition | I | 22, 33, 36, 38 | 5 | |||
| Entering historical data | O | 25 | 1 | |||
| HISb–practice fit | Staff requirements for implementation and maintenance | O | 26, 27 | 2 | ||
| Meeting needs and requirements | O | 22, 25, 27, 33, 37 | 5 | |||
| Capital available for practice expansion | O | 36 | 1 | |||
| Macro | Health care standards | HIS standards | Standardized medical terminology | O | 21 | 1 |
| Transience of vendors | O | 27 | 1 | |||
| Uniform data standards within the industry | O | 25, 33, 36 | 3 | |||
| Performance standards | Evaluation of changes to improve quality (general practice) | O | 36 | 1 | ||
| Quality problems (general practice) | O | 36 | 1 | |||
| Procedures and systems to prevent errors (general practice) | O | 36 | 1 | |||
| Practice standards | Adding to the skills of the practice | O | 30 | 1 | ||
| Standardized questions to ask vendors | O | 21, 25 | 2 | |||
| Model requests for proposal for contracts | O | 21, 25 | 2 | |||
| Funding and incentive | Remunerations | Payment for having or using system | O | 22, 36 | 3 | |
| Payment for patient survey results or clinical quality | O | 36 | 2 | |||
| Direct financial assistance | O | 25, 38 | 2 | |||
| Added values | 0 | |||||
| Incentive programs | Financial incentives for purchase and implementation | O | 21, 22, 25, 28, 35, 38 | 6 | ||
| Clarity of benefits | O | 28 | 1 | |||
| Legislation, policy and governance | Legislative acts | 0 | ||||
| Regulations and policies | Confidentiality | O | 22, 27, 28, 29 | 4 | ||
| Access and sharing of to medical records | O | 22, 29 | 2 | |||
| Intellectual property regulations | O | 28 | 1 | |||
| Self-referral prohibitions regarding sharing of technology | O | 25 | 1 | |||
| Government regulation requiring mandatory reporting of patient information | O | 28 | 1 | |||
| Governance bodies | Vendor certification and accreditation | O | 21, 25, 38 | 3 | ||
| Legal liability | O | 22 | 1 | |||
| Societal, political and economic trends | Societal trends | Competitive peer pressure in terms of more practices becoming computerized | O | 28 | 1 | |
| Recommendations of colleagues | O | 38 | 1 | |||
| Public or patient views for computerization | O | 26, 28, 33 | 3 | |||
| Political trends | 0 | |||||
| Economic trends | 0 | |||||
| Micro | System | Functionality | Features available and functions computerized | O | 21, 22, 25, 26, 27, 35, 39 | 9 |
| Intention to computerize functions | O | 26 | 1 | |||
| Features desired and functions that should be computerized | O | 21, 26, 29, 31, 32 | 10 | |||
| Features used | O | 22, 26, 35, 37, 38 | 5 | |||
| Features for patient use | O | 22 | 5 | |||
| Performance | Reliability of system | I | 22, 34 | 2 | ||
| System downtime | I | 27, 33 | 2 | |||
| Frequency of potential drug interaction alerts | I | 32 | 1 | |||
| How good system is in alerting for significant interactions | I | 32 | 1 | |||
| Concern system would become obsolete | O | 22 | 1 | |||
| Security | Security and privacy | I | 22, 25, 26, 27, 29, 33, 34, 35, 36 | 11 | ||
| Information | Availability | Information storage and retrieval | I | 30 | 1 | |
| Reliability of information | I | 32 | 1 | |||
| Accessibility of records and information | I | 21, 22, 24, 25, 27, 35, 36, 38 | 11 | |||
| Content | Value of clinical records | I | 26 | 1 | ||
| Accuracy of records | I | 21, 25, 38 | 3 | |||
| Drug interaction alerts providing information that is irrelevant to the patient | I | 32 | 3 | |||
| Amount of information provided | I | 32 | 1 | |||
| Reason for overriding alert: more faith in other sources of information | I | 32 | 3 | |||
| Grading interaction alerts according to severity | I | 32 | 1 | |||
| Service | Responsiveness | Training | I | 24, 29, 31, 34, 38 | 8 | |
| Level of support | I | 28, 31, 36, 37 | 4 | |||
| Use | Use behavior and pattern | 0 | ||||
| Self-reported Use | Use of information technology for clinical management activities | O | 27 (also see functionality) | 1 | ||
| Overriding alerts | I | 32 | 4 | |||
| Intention to use | 0 | |||||
| Satisfaction | Competency | Learning curve | O | 21, 25, 27, 28, 33 | 6 | |
| User satisfaction | Overall satisfaction | I | 21, 22, 39 | 4 | ||
| Annoyance caused by drug interaction alert messages | I | 32 | 1 | |||
| Usefulness in prescribing | I | 23, 32 | 2 | |||
| Ease of use of system or clinical module | I | 22, 23, 31, 33 | 5 | |||
| Ease of use | Data entry | I | 25, 27, 29, 33, 38 | 5 | ||
| Interface and customization | I | 39 | 1 | |||
| Net benefits | Quality: patient safety | Primary care and medical errors | I | 27, 29 | 3 | |
| Medication-related errors | I | 22, 24, 25, 35, 36, 38 | 8 | |||
| Quality: appropriateness and effectiveness | Disease prevention or management | I | 22, 30, 38 | 5 | ||
| Clinical decision making | I | 22, 25 | 3 | |||
| Clinical functions | I | 26 | 1 | |||
| Prescriptions | I | 22, 25, 30 | 3 | |||
| Legibility | I | 21 | 1 | |||
| Frequency of change in initial prescribing decision due to drug interaction alerts | I | 32 | 1 | |||
| Awareness of information provided by drug interaction alerts | I | 32 | 2 | |||
| Effect of computer use on patients’ satisfaction with care received | I | 34 | 1 | |||
| Patient–physician relationship and communication | I | 21, 22, 24, 25, 26, 27, 28, 34, 35, 36 | 10 | |||
| Documentation | I | 27 | 2 | |||
| Effect on medical practice; practice style | I | 39 | 1 | |||
| Health outcomes | Quality of patient care or clinical outcomes | I | 21, 24, 26, 27, 28, 29, 31, 35, 36 | 12 | ||
| Access: ability of patients and providers to access services | Remoteness in the provision of medical care | I | 30 | 1 | ||
| Patient or customer base and area of coverage | I | 30 | 1 | |||
| Access: patient and caregiver participation | 0 | |||||
| Productivity: efficiency | Accounting and billing or charge capture | I | 21, 25, 27, 30 | 7 | ||
| Assistance in test ordering and management | I | 22, 24 | 3 | |||
| Documentation time | I | 21, 24 | 3 | |||
| Business or practice efficiency | I | 21, 27, 28, 30, 33, 34, 35, 36, 39 | 10 | |||
| Time for medication refills | I | 38 | 1 | |||
| Time for patient care | I | 24, 26, 30 | 3 | |||
| Workload | I | 27, 30 | 4 | |||
| Productivity: care coordination | Communication with other providers | I | 22, 24, 27, 30, 35, 36 | 8 | ||
| Workflow | I | 21, 25, 27, 33, 37 | 5 | |||
| Productivity: net cost | Costs or savings | I | 21, 25, 27, 28, 30, 35, 36 | 10 |
a B = background, O = other, I = impact-specific area.
b Health information system.