Findings related to the demographic characteristics of the research community indicated that most subjects of the study had a personal computer at home. The average ICDL computer skills score of the participants was also in an acceptable range; there was also a direct correlation between ICDL skill scores and the score of personnel awareness of EHRS objectives. These findings indicate that the necessary conditions of computer skill awareness are already established in the study population so that it improves the research community's attitude and awareness of the goals and missions of the EHR. In this regard, Lorenzi and Riley in “Organizational Aspects of Health Informatics: Managing Technology Change'' (2013) acknowledge that one of the major challenges in implementing and using hospital information systems is the resistance of users, especially physicians and nurses, in adopting these systems as work tools. They point to the users’ worry about incapability in learning computer skills, being imposed by work discipline, wasting of the time, assignment of unwanted responsibilities and strict control, the fear of new demands creation, lack of competition and efficiency (9) as reasons. One of the important points in the present study regarding individual factors influencing the improvement of EHRS implementation is that the study population had suitable computer skills for some reasons. This characteristic was more prominent for hospital staff than for health center personnel. Since holding an ICDL certificate is one of the requirements for employment in Iran, employees usually have to learn these skills as a prerequisite for a job. Another item that is essential for better and more effective use of information systems by users is their knowledge about the objectives, benefits, and capabilities of information systems (15, 18). The present study showed that considering the workplace parameter, the staff of Medical Bureau of Health compared to 22 Bahman and Hakim hospitals, had significantly lower knowledge about the goals and missions of EHRS while the difference for 22 Bahman and Hakim hospitals was not statistically significant. These findings were consistent with the Amanda L. Terry et al., results; they showed that EHRS users did not have sufficient knowledge of EHRS processes (10). In a cross-sectional study, Lippert and Kverneland showed that the main reasons for the failure to implement the EHRS were lower resources allocated to the users’ preparation for adopting the program and their unfamiliarity with the goals and missions of the EHRS (19).In term of the attitude of the users toward the features and functions of HER, if EHRS users, have a good perspective of the information system or electronic file, this favorable perspective will increase effectiveness and enhance system adoption and utilization (16, 17). In the present study, the assessment of the research community's attitude revealed that the scientific community as a whole has a favorable view of the EHRS functions. Despite these favorable sentiments, Table 3 shows that users of information systems, including the EHR, have a negative attitude toward the system, which originates from a fear of consequences for their job position. This is also demonstrated in the present study (Table 3). According to the current study, after five years of implementation and operation of the system, employees believe that the existence of the EHRS weakens their job position by imposing new skills, duties, and producing additional expectations. In a paper titled "Electronic Health Record: Assessing the Staff Preparation," JEBRAEILI et al., found that the most negative attitude of employees toward the adoption of EHRS is related to job position risks (2.12 of 5), wasting time and increase in workload (2.49 of 5) (17). In this regard, hospital and healthcare officials must take the necessary measures for job security improvement, as well as modifying the staff beliefs and familiarizing them with the skills required for optimal use of the EHRS. The three identified organizational components that influenced the adoption of EHRS in this study were human, technological, and managerial factors. According to scientific sources and research, various human, technical, and managerial (organizational) aspects all have a part in the success or failure of the health information technology system (9). In their investigations, Yusof (2008), Kuziemsky (2015) and Zarghani et al. (2021) highlighted certain key technological, organizational, and human components of health information technology. Financing, leadership, organizational structure, personnel training, care delivery processes, user-friendliness of health information technology, and continuous and uninterrupted communication in health information systems are some of the topics they discuss (20–22).
According to the findings of our study, the most influential human element based on scores was the users' familiarity with the EHRS capabilities, while with the same criteria the least significant human element was "Ensuring information security and confidentiality in the EHR". The element "learning software related to the EHRS " received the highest score among the technical factors, while the component "problems of the EHRS " received the lowest score. Among the management factors, the component "lack of medical informatics and health management experts at the medical center inhibits the efficient use of the electronic health record system" received the highest score. In other words, one of the most critical problems highlighted by the research community about the adoption of EHRS in terms of technological elements has been the availability of suitable software. The research community has focused on funding and, in particular, providing the human resource with the necessary expertise from a management standpoint. The results of the present study support the findings of Lovita and Andriyani’s, demonstrating the need for staff training regarding the adoption and operation of information systems (23). The lack of healthcare practitioners’ engagement, as well as dominant organizational culture, are the most significant impediments to the implementation of electronic health records, according to Thakkar and Davis (24).The analysis of users' viewpoints in the current study revealed that, from their perspective, engaging in debugging procedures and encouraging active users by managers plays an important role in their adoption and implementation of this system, and it appears that the required organizational culture to utilize the information systems has established its place in the analyzed medical centers. The present study also revealed that a shortage of medical informatics expertise is one of the contributing factors to the inefficiencies of EHRS users. Despite the fact that enough medical informatics professionals are being trained at the present, this issue remains one of the barriers to adopting EHR. Naghipour and Ahmadi (25) and Nasiripour et al. (26),reported a scarcity of specialists and difficulties in hiring medical informatics professionals as barriers to adopting e-health and increasing staff productivity through the EHRS, confirming our findings in the research.