Previously submitted to: JMIR Medical Informatics (no longer under consideration since Jul 17, 2026)
Date Submitted: Feb 9, 2026
Open Peer Review Period: Feb 19, 2026 - Apr 16, 2026
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Using the Extended Technology Acceptance Model to Explore User Experience and Optimization Pathways of a Trusted Paperless Electronic Medical Record Management System Among Medical Record Administrators in a Tertiary Hospital in China: A Descriptive Qualitative Study
ABSTRACT
Background:
Trusted paperless electronic medical record (TPEMR) management system serves as critical infrastructure for hospital governance and compliance under the National Health Commission’s Electronic Medical Record System Application Level Grading Evaluation (CN-EMR Grading) framework in China. Understanding user experience (UX) with system usability, trust, and sustained engagement may improve the accessibility, acceptability, and sustained adoption of the administrative health information system.
Objective:
The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UX, use behaviors, intent to use and intent to continue using among medical record administrators.
Methods:
We conducted a descriptive qualitative study guided by the extended Technology Acceptance Model (TAM) in a tertiary hospital achieving CN-EMR Grade 5. Through semi-structured interviews and focus groups with medical record administrators (n=23) and information system–related personnel (n=5), we examined perceived usefulness (PU), perceived ease of use (PEOU), intent to use and intent to continue using by a trained coder. To enhance analytic rigor and credibility, the coder met weekly with the principal investigator to review coding decisions, resolve ambiguities, and ensure that interpretations remained grounded in the data.
Results:
Participants acknowledged TPEMR's routine efficiency in retrieval, batch printing, and compliance reporting. However, exception-handling workflows triggered significant usability breakdowns. "Surface usability, deep complexity" emerged as a core pattern: standardized tasks felt intuitive, while deviations required opaque, multi-step workarounds across departments. Recurrent system instabilities and non-actionable error messages eroded psychological trust, fostering defensive behaviors like manual tracking despite mandatory use policies.
Conclusions:
TPEMR optimization must move beyond happy-path efficiency to address exception-path resilience. Embedding visible compliance mechanisms, streamlining cross-departmental coordination, and providing transparent error recovery pathways are critical to converting mandated use into genuine, sustainable engagement among medical record administrators.
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