Seite - 69 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

as pioneer users will contribute significantly to the diffusion of home telehealth services among other users. The case study shows how the UTAUT-based survey can help to identify factors for the further optimization of health IT implementation before the technology is introduced. This case study is one of the few examples where TAM or UTAUT were used in settings where the technology was yet to be implemented. 3. Explanation of success or failure of health IT system TAM and UTAUT have been developed with the aim to understand better why users accept or reject technology, and to predict acceptance or non-acceptance of new technology. TAM and UTAUT define acceptance as the intention to use, or the willingness to use, a technology. The theories assume that intention to use is a direct determinant for actual system use. Thus, TAM and UTAUT attempt to reveal factors that have direct implication for the success or failure of technology, with success seen as equivalent to actual system usage. We must note that TAM und UTAUT have not been developed within a health care setting. TAM was developed based on studies of an e-mail system and a word processing system [3]. UTAUT was validated based on studies related to introducing an online meeting manager, a database application, and an accounting system [2]. These types of application seem not comparable to much more complex health care technologies, such as computerized physician order entry systems, electronic health record systems, or nursing documentation systems. In addition, these latter types of technologies represent socio-technical information systems where the acceptance of a technology depends not only on its functionality or ease of use, but on many other factors such as hardware performance, training, support, and workflow integration. In particular, besides individual factors shaping decisions to use a technology, organizational, cultural and emotional factors will also influence technology acceptance in healthcare settings [14]. Overall, these socio-organizational-cultural factors are not well covered by TAM and UTAUT. Besides, TAM was developed with a focus on technology which can be used voluntarily. Typically, in health care, most technologies are mandatory to be used by the staff. This all distinguishes healthcare from the settings where TAM and UTAUT were developed and used. Nevertheless, as the case studies and a short query in PubMed show, TAM and UTAUT have found wide adoption in health care. Reasons for this can be the quite simple assumptions of both models: System usage depends on only two (TAM) or four (UTAUT) key variables, including the usefulness of the system for the work and the ease-of-use of the system. This sounds quite intuitive and may have contributed to their popularity. Still, in many health care studies where TAM or UTAUT were applied, authors have added variables to extend the original TAM or UTAUT models to better adapt it to the context of health care. Case study 2 [13] showed an example of this: The authors assess the acceptance of home telehealth services by elderly patients and added three context- specific predictors, namely Doctor’s Opinion, Computer Anxiety, and Perceived Security. The authors argue that the “universal” variables in UTAUT are not specific enough for health care and thus decided to add these three “context-specific” variables as potentially important predictors for the acceptance of the telehealth service. And indeed, all three context variables were found to be important predictors in the study. E.Ammenwerth /TechnologyAcceptanceModels inHealth Informatics: TAMandUTAUT 69