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Health Dataspace Technology Acceptance Model (HDS-TAM): Development and Case Evaluation Study of Patient Acceptance of Germany’s Electronic Patient Record

Year: 2026

Type: article

Abstract: Background The European Health Dataspace (EHDS) expands health data sharing beyond direct care and introduces governance, transparency, trust, and secondary-use considerations that are not fully captured by established technology acceptance models such as the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). To address this gap, we developed the health dataspace technology acceptance model (HDS-TAM) and evaluated it using the German electronic patient record (ePA) as an illustrative health dataspace (HDS) application. Objective This study aimed (1) to derive an HDS-oriented technology acceptance framework from the literature and (2) to assess its applicability in explaining acceptance of the ePA from a patient perspective. Methods A structured literature review screened 1788 records, reviewed 134 full-text papers, and retained 68 studies for model development. HDS-TAM was subsequently applied in a scenario-based online survey conducted between March and April 2025. Of 235 questionnaire accesses and 163 submitted responses, 149 valid responses were analyzed. Data were analyzed using multiple imputation, exploratory factor analysis, and partial least squares structural equation modeling (PLS-SEM). The association between behavioral intention and actual ePA use was examined using logistic regression. Results The model explained 75.9% of the variance in behavioral intention to use (BI, R ²=0.759), 67% in perceived usefulness (PU, R ²=0.670), and 54% in perceived risk (PR, R ²=0.540). PU showed the strongest positive association with BI ( β =.670, P <.001, f ²=0.457), whereas PR showed a small negative association ( β =−.149, P =.04, f ²=0.034). Transparency was positively associated with PU ( β =.220, P =.001) and perceived ease of use (PEOU; β =.454, P <.001) and negatively associated with PR ( β =−.594, P <.001). Perceived need (PN) showed a strong positive association with PU ( β =.567, P <.001) but no significant direct association with BI ( β =.071, P =.35). Eight of 20 hypotheses were supported. Only 23.5% (n=35) of participants reported actual ePA use. BI showed a positive but imprecise and nonsignificant association with self-reported actual use (OR 1.37, 95% CI 0.89-2.11, P =.15). Measurement quality was mixed: reflective constructs generally showed satisfactory reliability and convergent validity; however, discriminant validity between PU and BI was poor (heterotrait-monotrait ratio of correlations [HTMT]=0.981). Conclusions PU showed the strongest association with behavioral intention in the ePA case evaluation, while transparency and PN were mainly associated with behavioral intention through indirect pathways. The findings suggest potential value in extending traditional acceptance models with governance-related constructs relevant to HDSs. However, the severe overlap between PU and behavioral intention, low actual ePA uptake, and the young, highly educated convenience sample limit confidence in the magnitude and distinctiveness of the observed effects. HDS-TAM should therefore be regarded as a promising but preliminary framework requiring further refinement and validation.

Source: JMIR Medical Informatics

DOI: 10.2196/99366

Authors: Veronika Vasileva, Eduard Wolf, Volker Riediger, Amir Shayan Ahmadian, Daniel Buschmann, Jan Jürjens

Institutions: University of Koblenz and Landau, Universität Koblenz, Fraunhofer Institute for Software and Systems Engineering

Language: English

Topic: Electronic Health Records Systems

Subfield: Health Information Management

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,300