currently , technology development has become one of the strategic elements in organizations , so that the effects of changes in the social , economic , and political systems have been more than the technologies themselves ( 1 ) .
the health system was not far from the outcomes , but the paper records , because of their own limitations , are not capable of proper communication between health service providers , and the data that are needed may not be available in a timely manner ( 2 ) . to solve the problem , moving toward health information systems began about 30 years ago , and the ultimate goal of this movement was to improve the access to electronic health records ( 3 ) .
use of information technology in various sectors of health care , particularly in hospitals , has great potential to improve the quality of services provided and the efficiency and effectiveness of staff , and they also reduce some of the organizational costs ( 4 ) .
studies have shown that using electronic records in today s complex health system faces many challenges that require organizational preparation and workforce readiness .
researchers and policymakers who are running a new information system can measure the acceptance of the system among the target population .
therefore , before the implementation , technical and non - technical factors must be identified , and the barriers to implementation must be eliminated ( 5 ) .
models present the process of implementing new technologies by assuming a number of systemic factors that jointly or independently predict success in the implementation phase ( 6 ) .
implementation of health information systems may fail due to their being rejected by the users , so it is important to anticipate the reasons that physicians and other members of the medical team may have to accept or reject the new information system .
this information will allow an organization to actively implement reforms to increase the acceptability of the new systems ( 79 ) .
considered the users attitudes to have a significant effect on the success of the implementation of electronic health records , and they emphasized the importance of being familiar with the applications and the concepts of electronic health records ( 10 ) . in recent decades , several models have been proposed in the field of technology acceptance . among these models
are the  task - technology fit ( ttf ) model ,  the  technology acceptance model ( tam ) ,  and the  unified theory of acceptance and use of technology ( utaut ) model .
 it theories to predict the response of end - users in it are very important ( 11 , 12 ) . in terms of technology acceptance , there are many theories and patterns , some of which have been used in the health care field .
the utaut model , as an integrated theory of eight other models , is necessary in technology acceptance ( 11 ) . in this paper
, we discuss the most important factors affecting the acceptance of the current and different information systems in health systems that have used technology acceptance theories .
from the databases of web of science , science direct , google scholar , pubmed , and scopus , related english language articles were searched ; from the google scholar database , persian language articles were searched and located .
he keywords used included adoption , use , acceptance of it in medicine , hospitals , it theories in health services , as well as several important technologies , including electronic health records ( her ) , electronic patient records ( epr ) , electronic medical records ( emr ) , computerized physician order entry ( cpoe ) , hospital information system ( his ) , picture archiving and communication system ( pacs ) , also were included in the keyword search in order to conduct a comprehensive review .
also in our searches , we enlisted the help of a search specialist in order to improve the quality of our searches .
one of the inclusion criteria was that the studies be in the english or persian languages .
also , studies related to the period of 20042014 were included in the study . among articles , the ones before 2004 , review articles , papers that did not use the theory of it , and articles with less than 30 references were excluded .
quality assessment of articles was conducted using the strobe ( strengthening the reporting of observational studies in epidemiology ) checklist .
if disagreements occurred among the two researchers , the issue was referred to a third researcher .
from the databases of web of science , science direct , google scholar , pubmed , and scopus , related english language articles were searched ; from the google scholar database , persian language articles were searched and located .
he keywords used included adoption , use , acceptance of it in medicine , hospitals , it theories in health services , as well as several important technologies , including electronic health records ( her ) , electronic patient records ( epr ) , electronic medical records ( emr ) , computerized physician order entry ( cpoe ) , hospital information system ( his ) , picture archiving and communication system ( pacs ) , also were included in the keyword search in order to conduct a comprehensive review .
also in our searches , we enlisted the help of a search specialist in order to improve the quality of our searches .
one of the inclusion criteria was that the studies be in the english or persian languages .
also , studies related to the period of 20042014 were included in the study . among articles , the ones before 2004
, review articles , papers that did not use the theory of it , and articles with less than 30 references were excluded .
quality assessment of articles was conducted using the strobe ( strengthening the reporting of observational studies in epidemiology ) checklist .
if disagreements occurred among the two researchers , the issue was referred to a third researcher .
table 1 shows the number of articles found on the discussed technologies . according to the articles , we investigated the adoption of health information technology , electronic medical records , electronic health records , hospital information systems and clinical decision - making support system , reporting systems , mobile phones , tablets and personal computers , electronic versions and other new technologies and websites .
table 2 shows the number of cases that were found using different theories of information technology ( it theory ) in the field of health , and the technology acceptance model had the most usage among researchers in the field of health , followed by the combination of different models and utaut .
also , the theory of planned behavior and diffusion of innovation theories were used in a few cases . by perceived usefulness ,
we mean the extent to which a person believes that using the system will increase efficiency and achievement of the desired goals .
the perceived ease of use factor included factors distinct from the system and also the extent to which the user assumes that the work will be easier with the technology ( 13 ) .
social impact is the extent to which a person believes that using the system from the perspective of others is important .
facilitating conditions are the extent to which a person believes the technical and organizational infrastructure will support the utilization of the system ( 14 ) .
attitude to use is the judgment and assessment of the people of the ultimate goal of an act or conduct in various aspects ( 12 ) .
user behavior is the extent to which the users behaviors towards a particular technology will be considered ( 15 ) .
table 3 shows the factors affecting technology adoption in the articles that were selected in order of importance in the reviewed studies ; based on the papers , the most important factors affecting the adoption of information technology in the health system are the perceived ease of use , perceived usefulness , social influence , facilitating conditions , attitude to use , and users behaviors .
among the selected articles , more than all technologies , the adoption of health information technology was studied . in the articles , after health information technology , electronic medical records were examined since they are required for health records , and having a complete ehr requires the successful implementation of electronic medical records ( 16 ) , hence , it was allocated more attention than some other areas .
developing countries must implement electronic medical records to manage patients ( 17 ) , but they are in the prior levels of the process of implementing electronic health records ( 16 ) . in a study by the american medical association ( institute of medicine ) in 2001 , only 31% of physicians stated that the use of ehr will ease the management of medical procedures ( 18 ) so , more research is required on the technology that is required for the implementation of her . also , the systems that were studied in papers were quite varied and encompassed a wide range of health information technologies . in the papers that were selected ,
the model was used the most was the tam model , which is one of the extensive behavioral models in the it field ( 19 ) and is the most common model ( 12 ) . in 2005 , chau and hu studied 40 models of technology adoption and came to the conclusion that technology acceptance model shows validity , reliability , power , and simplicity of it ( 20 ) , and additional studies that were conducted showed the high ability of the tam to demonstrate the technology adoption among physicians ( 21 , 22 ) . for these reasons , to investigate the different technologies in the health system , tam also has the most use .
the results of studies in the field of health information technology suggest that more researchers are using a combination of models and are interested in developing and offering their models . in 2012 , putzer et al . used a combination of technology adoption and diffusion of innovation for mobile acceptance among physicians ( 23 ) . in 2014 , in meki s study , the technology acceptance model was developed ( 24 ) , and aggelidis et al .
( 4 ) proposed a model based on the technology acceptance model that showed 87% intention to use the technology .
the template provided by chau and hu ( 20 ) based on a unified theory of acceptance and use of technologies developed by venkatesh et al .
, as unified theory of acceptance and use of technology ( 25 ) , and the model proposed by haselina for the adoption of electronic medical records ( 15 ) are only a small sample of researchers interest in the development of models to adopt technology in the field of healthcare .
( 26 ) used the factors of technology acceptance and several other factors , such as administrative support , occupations , authority of physicians , and doctor - patient relationships as the factors affecting the use of electronic medical records .
( 27 ) in their study in 2013 used the technology acceptance model and other factors , such as the user interface and data quality , in order to assess the use of electronic medical records .
( 28 ) used the unified theory of acceptance and use of technology and several other factors that can show up to 76% the intention for use .
a literature review showed that the use of a unified theory of acceptance and use of technology by researchers has increased in recent years .
the resulting unified theory of acceptance and use of technology was a long line to offer the different models of technology adoption that was presented in 2003 ( 11 ) , and up to 70% can indicate the intention to use the system ( 14 ) .
also , in two cases of studies , a combination of planned behavior models was used with other models , and , in one case , innovation diffusion theory was used that according the universality of the adoption and use of technology the need is not so much for the use of such models ( 12 ) .
papers in the study showed that the perceived ease of use , perceived usefulness , social impacts , facilitating conditions , attitude to use , and users behaviors were the most important factors affecting the adoption of information technology in the field of health .
the remarkable thing is that , in the literature , the most important factor in technology adoption was the simplicity of perceived usage .
howard & warner ( 29 ) came to the conclusion that the key to willing acceptance of electronic medical documents by physicians was perceived ease of use .
ground et al . ( 30 ) assessed the perceived ease of use and perceived usefulness in acceptance of storage system and process of images important .
also , according to davis , perceived ease of use of the system was relatively more important than ease of use itself , because users often want to be faced with a system that is difficult to use provided that the system can meet the needs of their practical applications ( 31 ) .
the results showed that the technology acceptance model , perceived usefulness , and perceived ease of use are the most important factors in technology adoption and in an integrated model of adoption and use of technology , social impacts have a greater role in the adoption and use of technology in the field of healthcare . in a study by holtz and krein ( 32 ) in 2011 , the most important factor in the adoption of electronic patient records was considered to be social impacts . in 2008 , wills et al .
( 11 ) concluded that social impacts have an important role in the decision to use electronic medical records .
( 6 ) found the social impacts to be one of the most important factors affecting the adoption of health information technology .
however , a study by jason ( 33 ) showed that social impacts had less influence on the adoption of electronic prescribing in south africa .
in the studies , a number of factors in addition to the technological theories were found .
for example , monem et al . ( 34 ) considered the user s role and her or his personal understanding of the system as important factors in technology adoption . in a study in 2012 by putzer et al .
( 23 ) to determine the new factors influencing the use of smartphones by physicians in clinical decision making , they concluded that factors such as adjustment , interaction in the workplace , internal environment , visibility , personal experience , and external environment are the main factors affecting the attitudes of physicians in the use of smartphones .
the results showed that , using models 1 , 2 , and 3 , factors affecting the adoption of health information technology can be assessed .
also , when managers and policy makers want to implement health information technology , perceived usefulness and perceived ease of use are factors that should be considered . due to the role of information technology adoption theories in successful implementation of information technologies , it is suggested that managers and policy makers study the affecting factors before implementing health information technologies .
 introductionthe successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them . the aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology.methodsthis systematic review was conducted by searching the major databases , such as google scholar , emerald , science direct , web of science , pubmed , and scopus . 
 we used various keywords , such as adoption , use , acceptance of it in medicine , hospitals , and it theories in health services , and we also searched on the basis of several important technologies , such as electronic health records ( her ) , electronic patient records ( epr ) , electronic medical records ( emr ) , computerized physician order entry ( cpoe ) , hospital information system ( his ) , picture archiving and communication system ( pacs ) , and others in the 20042014 period.resultsthe technology acceptance model ( tam ) is the most important model used to identify the factors influencing the adoption of information technologies in the health system ; also , the unified theory of acceptance and use of technology ( utaut ) model has had a lot of applications in recent years in the health system . 
 ease of use , usefulness , social impact , facilitating conditions , attitudes and behavior of users are effective in the adoption of health information technologies.conclusionby considering various factors , including ease of use , usefulness , and social impact , the rate of the adoption of health information technology can be increased . 
1. Introduction
2. Material and Methods
2.1. Searching articles
2.2. Inclusion and exclusion criteria
2.3. Quality assessment
3. Results
4. Discussion
5. Conclusions