Table 2.

eHealth acceptance factors under 7 clusters.

Cluster and factors		Definitions and citations
Health care provider characteristics
	IT experience and knowledge	Generic IT skills (eg, typing skills) and experience [24,30-47] Those who had little experience with computers were challenged by the process of learning how to use the computer in addition to learning the software [43]   Previous experience of computer use in medical practice or training in using particular eHealth systems [48-56] Respondents with an electronic health record (EHR) were more likely to e-prescribe than those who did not have an EHR, and to have patients take a computer-generated prescription to the pharmacy [55]
	Years in practice	Total years in practice since medical school graduation [32,48,57-61] Based on the comments offered by those in practice for longer than 25 years in our study, it did not make sense to invest time or money at this point in their careers [32]
	Role	Variation between physicians and other health professionals [53] Physicians use most of the advanced features more than nonphysicians [53]   Variation between specialists and others [59,62,63] high-end specialists, such as obstetrician-gynecologists, are less likely to be using EHR in their practice [63]
	Age	Physical age [36,39,46,59,61,64-67] EMR use was inversely associated with physician age [65]
	Gender	Biological sex [39] Females were less likely to use PDAs [39]
	Race	A group of people of common ancestry, distinguished from others by physical characteristics [39] African American and Hispanic physicians were more likely than Caucasian to indicate routine PDA use; Asian physicians reported using email with patients significantly less frequently than their Caucasian counterparts [39]
Medical practice characteristics
	Practice size	Number of physicians in the medical practice [36,39,48,57,58,60,61,65,67-72] Physicians in practices with 11 or more physicians were most likely to use any EMR system, whereas physicians in solo practice were least likely to use EMRs [65]   Number of patient visits [24,32,61,72,73] who saw fewer than ten patients per day, reviewed fewer than 20 medical records per day and handled fewer than ten calls daily, were statistically less likely to want to use a computer during a consultation; Those seeing fewer than ten patients daily were the most receptive to the use of handwriting [32]
	Teaching status	Practices affiliated with academic institutions [58,70-72] There was a statistically significant association between presence of students and residents in a practice and the practice’s use of an her [71]
	Location	The medical practice in a rural setting or urban setting [40,61,68,72-74] urban settings were significantly more likely to have adopted AIMS [72]
	Single/Multi-specialty	Difference between those in a single-specialty practice and in a multi-specialty practice [39,65,66,68,75] those in a multi-specialty group were more likely than those in a single specialty practice to routinely use EHRs [39]
	Practice level	Distinctions between Primary, Secondary and Tertiary health care [36,58,60] physicians whose practice consisted of a specialty other than primary care were more likely to use an EHR [60]
	Types of third-party payers	Proportion of patients who are privately insured, Medicaid, Medicare, or uninsured [48,66,73,76] Physicians with the highest percentage of Medicaid patients in their practices were significantly less likely to indicate using an EHR system when compared with those in the low-volume Medicaid group [76]
	Patient Age Range	The age range of served patients’ [67] doctors who treat HVE a were significantly less likely to adopt EHR [67]
Voluntariness of use
	Perceived voluntariness	The degree to which use of the innovation is perceived as being voluntary, or of free will [77] Perceived voluntariness had a negative causality on behavioral intention to use telemedicine. These findings contradict those from prior IS literature that found a positive relation between voluntariness of use and intention to adopt [77]
Performance expectancy
	Perceived usefulness and needs	The degree to which a health care provider believes that using the eHealth system would enhance his or her clinical or non-clinical job performance [24,25,28,29,33,35,36,38,41,43,46,50,56,75,77-91]   Perceived needs of adopting the eHealth system [42,79,92-94] Participants from private hospitals or who owns a private practice reported that most of their patients are one-time customers and they do not expect them to come back. For private hospitals, about 30% of their patients are from out of the state (mostly from near towns and villages). Therefore, they do not keep their past medical records [93]
	Relative advantage	The degree to which using an innovation is perceived as being better than using its precursor of practices [5,45,59-61,72,93,95,96] physicians who used electronic prescribing were significantly more likely to view it as saving time than those who have not adopted the technology [5]
	Job-fit	How the capabilities of the eHealth system enhance a health care provider’s clinical job performance [24,40,97] no mechanism of alerting inpatient physicians that finalized test results were available for viewing (eg, by email or by an alert in the inpatient computer system [97]
	Reimbursement and financial incentive	The degree of a health care provider’s perception of uncertainty over return on monetary investment [5,24,26,31,40,73,86,90,91,95,98]   Availability of financial reward for a health care provider’s time investment in learning and using the eHealth system [36,54,70,86,92,99] the availability of incentives for adoption of HIT were more likely to have EHRs than practices without such incentives [70]
Effort expectancy
	Perceived Ease of use	The degree to which a health care provider believes that using the eHealth system would be free of effort [5,25,28,29,38,40,46,47,52,54,56,68,74,75,81,84,87,88,90] co-existence of paper and electronic records at the transition period, as an important barrier to EMR adoption [74]
	Ease of use	The degree to which using the eHealth system is perceived as being difficult to use [5,27,28,35,41,45,46,52-54,64,77,84-86,89,91,97,100-103] a perception that technical system deficiencies reduce the quality of clinical routines can result users’ resistance [103]   Location of ICT equipment for convenient use of the eHealth system [41,45,49,96,101,102] Sometimes the physician practice does not have appropriate equipment to facilitate use of the e-Prescribing system as part of the existing workflow. For example, if they do not have a handheld device or computer in the examination room, the busy clinician needs to use a PC outside the examination room, adding an extra step to the workflow [49]
	Complexity	The degree to which the eHealth system is perceived as relatively difficult to understand and use [24,26,35,37,45,46,54,79,84,86,89,93,96,100,101] this study indicated that the EMR systems are very complex and difficult to learn, and this affects their attitude towards using the EMR systems [93]
Social influence
	Subjective norm	The health care provider’s perception that most people who are important to him or her thinks he or she should or should not adopt the eHealth system in question [40,59,77,91] Patient resistance or not wanting their physicians to use EHR [40]
	Competition	Perceived competitive advantage with eHealth [48,86,94] adopt mobile technologies to gain a competitive advantage; adopting IS creates a competitive advantage by giving businesses new ways in which to outperform their rivals [94]
	Supportive organizational culture for change	Leadership and presence of champions for the eHealth system adoption within a health care setting [24,35,38,43-45,74,79,86,96,104] Health care professionals were likely to accept and participate in the process of eHealth adoption when the programs were introduced and promoted by a peer with considerable authority and influence and familiarity with the practices [79]   The degree of a health care provider’s perception of organizational culture (eg, learning culture) supportive to eHealth adoption [33,105] The culture of the organization, including its supportive elements, influences both implementation and persistence of the work innovation [33]
	Friendship network	Personal intimacy and interactions with personal friends [47] Social influence affecting physician adoption of EHR was predominantly conveyed through interactions with personal friends rather than interactions in professional settings [47]
Facilitating or inhibiting conditions
	Computer self-efficacy	A health care provider’s self-judgment of his or her ability to use the eHealth system to accomplish clinical jobs or tasks [46,48,67,77,86]
	Computer anxiety	Evoking anxious or emotional reactions when it comes to adopting the eHealth system [24,33,40,77,80,92,106] They are concerned that under certain circumstances, or as time passes, the systems will reach their limitations, become obsolete and will no longer be useful [24]
	Legal concerns	The availability of the policy, regulation, and protocol supportive to using the eHealth system [31,54,74,78,79,82,93,95] Regulation regarding sharing of clinical information between the various EMR users across settings of care could represent a complex issue. During interviews, some respondents expressed concern with respect to the application of the law related to patients’ consent in the context of EMR implementation [74]
	Financial constraints	The degree of a health care provider’s perception of high monetary cost for adopting the eHealth system (ie, start-up costs and ongoing maintenance costs) and of the availability of financial resources to cover the cost [5,25,27,28,30-33,35,37,39,41,50,52,53,58,60,62,69,71-75,79,80,85-87,91,93,94,107-110] respondents noted the lack of capital to invest in EHRs as an important or very important barrier to adoption [73]
	Availability of ICT infrastructure	The degree of a health care provider’s perception of the availability of ICT infrastructure required for using the eHealth system [24,35,38,49,51,79,81,91,107]
	Time cost	Time required to select, purchase, and install the eHealth system [5,24,37,40,59,61,86,90] Implementing an EMR means switching from paper-based to electronic based systems, and this involves transferring records between the two systems [24]   Time involved in learning to use the eHealth system and additionally required to become familiar with the system operation [25,28,31,32,37-39,41,44,46,50,53,55,57,60,62,71,72,74,85,87,91,92,109,110] the time and effort involved in learning to use these technologies as a significant barrier [31]   The degree to which use of the innovation is perceived as being time consuming [24,35,84,86,90,93,97,99-101] takes too much time to enter data in real time [93]
	Interoperability	The degree of a health care provider’s perception of the ability of the eHealth system to exchange and use relevant clinical data within and across the health care setting [24,26,31,32,38,49,72,73,86,91,92,103,104] Lack of ability to exchange clinical data with laboratories and hospitals is a major barrier for smaller physician practices [31]
	IT support	The degree of a health care provider’s perception of the availability of experienced IT personnel for technical support (eg, troubleshooting emergent problems during actual usage of the eHealth system, and providing instructional and/or hand-on support to users before and during usage) [24,26,28,30,31,34-38,54,57,72,74,79,81,84,91,94,100] the provision of good maintenance and user support systems greatly increases user acceptance of a new system [84]   The degree of a health care provider’s perception of the adequacy of training for the usage of the eHealth system [24,27,35,38,41,43,44,50,53,71,75,78,79,92,100,103,108] This study found that inadequate training limits EMR utilization [108]
	eHealth and business process alignment	The degree of a health care provider’s perception of the fitness of the eHealth system into the clinical workflow [29,32,77,96,97,99,103]
	End user involvement	The involvement of end users in the planning and implementation process of the eHealth system [24,38,75,83,84,86-88,103,104] Clinicians’ resistance was also related to whether or not they had been involved in the design and implementation process [103]
	Management commitment and support to change	The presence of management commitment and availability of management support for adoption of the eHealth system [24,33,45,75,79,81,82,87,88,91,92,103,109] the implementers’ responses were supportive and addressed the issues related to the real object of resistance; the severity of resistance decreased [109]
	Uncertainty about IT vendor	The degree of a health care provider’s perception of the availability of reputable and trustworthy external IT service providers in the market [24,29,49,52,106]
	Professional autonomy	The degree to which using the eHealth system is perceived by a health care provider as losing professional control over the conditions, processes, procedures, or content of his or her work according to the individual judgment in the application of his or her profession's body of knowledge and expertise [24,42,75,86-89,91,110,111] With the implementation of EMRs, physicians are concerned about the loss of their control of patient information and working processes since these data will be shared with and assessed by others. Physicians’ perceptions of the threat to their professional autonomy are very important in their reaction to EMR adoption [24]
	Interference with health care provider-patient relationship	The degree to which using the eHealth system is perceived as interfering the health care provider-patient relationship during their encounter [24,33,36,46,50,75,86-88,91,92,112] physicians who value a close patient relationship have less positive attitudes about the EMR [33]
	Patient privacy concerns	The degree of a health care provider’s perception of the security of patient information and protection of patient privacy [24,30,31,40,79,89,111,112]

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