This study discusses the role of behavioral intentions towards a Clinical Decision Support System in La Paz – Bolivia, more specifically Caja Nacional de la Salud (CNS) - La Paz. Specific Research on clinical decision support systems (CDSSs) is limited in the area of computer science and engineering and is rarely seen in behavioral intention analysis. Additionally, previous studies on CDSS are not focused on diagnosis of patients. This study identified whether there is an interrelationship
among the research variables by testing the model developed through survey research. A 47-item questionnaire survey targeted at CNS doctors and specialist in the area of Aneurysms was conducted to develop and validate a measure of users behavioral and to assess its impacts and antecedents. Performance Expectancy, Effort Expectancy were found to exert a significant influence on Attitudes Towards Use. Behavioral Intentions was found to be positively influenced by Attitude Towards Use. Thus, Social Influence does not have a positive impact on Behavioral Intentions, it does not have a positive impact on Attitudes Towards Behavior. Understanding Behavioral Intentions, then, is important to the successful implementation of the clinical decision support systems in the medical area.

Adams, D., Nelson, R., & Todd, P. (1992). Perceived Usefulness, Ease of Use and Usage of Information Technology: A Replication. MIS Quarterly, 227(47).
Agarwal, R., & Prasad, J. (1997). The Role of Innovation Characteristics and Perceived Voluntariness in the Acceptance of Information Technologies. Decision Sciences, 28(3), 557-582.
Agarwal, R., & Prasad, J. (1998). A Conceptual and Operational Definition of Personal Innovativeness in the Domain of Information Technology. Information Systems Research, 9(2), 204-215.
Agarwal, R., & Prasad, J. (1999). Are Individual Differences Germane to the Acceptance of New Information Technologies? Decision Sciences, 30(2), 361-391.
Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), 179-211.
Bagozzi, R. P. (1992). The Self-Regulation of Attitudes, Intentions, and Behavior. Social Psychology Quarterly, 55(2), 178-204.
Bajaj, A., & Nidumolu, S. R. (1998). A feedback model to understand information system usage. Information & Management, 33(4), 213-224.
Balas, E. A., Austin, S. M., Mitchell, J. A., Ewigman, B. G., Bopp, K. D., & Brown, G. D. (1996). The Clinical Value of Computerized Information Services: A Review of 98 Randomized Clinical Trials. Arch Fam Med, 5(5), 271-278.
Basaglia, S., Caporarello, L., Magni, M., & Pennarola, F. (2008). Individual Adoption of Convergent Mobile Technologies In Italy Interdisciplinary Aspects of Information Systems Studies (pp. 63-69).
Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., & Sheridan, T. (2001). Reducing the Frequency of Errors in Medicine Using Information Technology. Journal of the American Medical Association, 8(4), 299-308.
Bates, D. W., Kuperman, G. J., Wang, S., Gandhi, T., Kittler, A., Volk, L., et al. (2003). Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. Journal of the American Medical Informatics Association, 10(6), 523-530.
Bergman, L. G., & GH, U. (2005). Computer-aided DSM-IV-diagnostics – acceptance, use and perceived usefulness in relation to users' learning styles. Medical Informatics and Decision Making, 5(1).
Bueno, S., & Salmeron, J. L. (2008). TAM-based success modeling in ERP. Interacting with Computers, 20(6), 515-523.
Burnkrant, R. E., & Cousineau, A. (1975). Informational and Normative Social Influence in
Buyer Behavior. The Journal of Consumer Research, 2(3), 206-215.
Byrd, T. A. (1993). Expert Systems in Production and Operations Management: Results of a
Survey. Interfaces, 23(2), 118-129.
Castaeda, J. A., Muoz-Leiva, F., & Luque, T. (2007). Web Acceptance Model (WAM):
Moderating effects of user experience. Information & Management, 44(4), 384-396.
Changchit, C., Holsapple, C. W., & Madden, D. L. (2001). Supporting managers' internal
control evaluations: an expert system and experimental results. Decision Support
Systems, 30(4), 437-449.
Chau, P. Y. K. (1996). An empirical assessment of a modified technology acceptance model.
Journal of Management Information Systems, 13(2), 185-204.
Chismar, W. G., & Wiley-Patton, S. (2003). Does the Extended Technology Acceptance
Model Apply to Physicians. Paper presented at the Proceedings of the 36th Hawaii
International Conference on System Sciences - 2003, Hawaii.
Clocksin, W. F. (2003). Artificial Intelligence and the Future. Philosophical Transactions:
Mathematical, Physical and Engineering Sciences, 361(1809), 1721-1748.
Compeau, D., & Higgins, C. (1995). Computer Self-Efficacy: Development of a Measure and
Initial Test. MIS Quarterly, 19(2), 189-211.
Compeau, D., Higgins, C. A., & Huff, S. (1999). Social Cognitive Theory and Individual
Reactions to Computing Technology: A Longitudinal Study. MIS Quarterly, 23(2),
145-158.
Coursey, D. H., & Shangraw, R. F., Jr. (1989). Expert System Technology for Managerial
Applications: A Typology. Public Productivity Review, 12(3), 237-262.
Curran, J. M., Meuter, M. L., & Surprenant, C. F. (2003). Intentions to Use Self-Service
Technologies: A Confluence of Multiple Attitudes. Journal of Service Research, 5(3),
209-224.
Davis, F. D. (1989). Perceived Usefulness, Perceived Ease of Use, and User Acceptance of
Information Technology. MIS Quarterly, 13(3), 319-340.
Davis, F. D., Bagozzi, R. P., & Warshaw, P. R. (1989). User Acceptance of Computer
Technology: A Comparison of Two Theoretical Models. Management Science, 35(8),
982-1003.
Davis, F. D., Bagozzi, R. P., & Warshaw, P. R. (1992). Extrinsic and Intrinsic Motivation to
Use Computers in the Workplace. Journal of Applied Social Psychology, 22(14),
1111-1132.
57
Dreiseitl, S., Binder, M., Vinterbo, S., & Kittler, H. (2007). Applying a decision support
system in clinical practice: Results from melanoma diagnosis. Paper presented at the
Annual Symposium Proceeding, Austria.
Eagly, A., & Chaiken, S. (1993). The psychology of attitudes. Orlando, FL: Harcourt Brace
Jovanovich.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to
theory and research MA: addison-wesley foreign products. Journal of Advertising
Research, 47(1), 25-32.
Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J.,
Beyene, J., et al. (2005). Effects of Computerized Clinical Decision Support Systems on
Practitioner Performance and Patient Outcomes: A Systematic Review. Journal of the
American Medical Informatics Association, 293(10), 1223-1238.
Goodhue, D. (1988). I/S attitudes: toward theoretical and definitional clarity. SIGMIS
Database, 19(3-4), 6-15.
Goodhue, D. L., & Thompson, R. L. (1995). Task-Technology Fit and Individual
Performance. MIS Quarterly, 19(2), 213-236.
Hair, J. F., Black, B., Babin, B., Anderson, R. E., & Tatham, R. L. (2006). Multivariate Data
Analysis (6th ed.): Prentice Hall International.
Hartwick, J., & Barki, H. (1994). Explaining the Role of User Participation in Information
System Use. Management Science, 40(4), 440-465.
Hsu, C.-L., & Lu, H.-P. (2004). Why do people play on-line games? An extended TAM with
social influences and flow experience. Information & Management, 41(7), 853-868.
Hu, P. J., Chau, P. Y. K., Sheng, O. R. L., & Tam, K. Y. (1999). Examining the technology
acceptance model using physician acceptance of telemedicine technology. Journal of
Management Information Systems, 16(2), 91-112.
Hunt, D. L., Haynes, R. B., Hanna, S. E., & Smith, K. (1998). Effects of Computer-Based
Clinical Decision Support Systems on Physician Performance and Patient Outcomes: A
Systematic Review. Journal of the American Medical Association, 280(15), 1339-1346.
Igbaria, M., Parasuraman, S., & Baroudi, J. J. (1996). A motivational model of
microcomputer usage. Journal of Management Information Systems, 13(1), 127-143.
Inc., W. F. (2009, 2 June 2009). Clinical Desicion Support Systems, 2009, from
http://en.wikipedia.org/wiki/Clinical_decision_support_system
Jackson, C. M., Chow, S., & Leitch, R. A. (1997). Toward an Understanding of the
Behavioral Intention to Use an Information System. Decision Sciences, 28(2), 357-389.
Johnston, M. E., Langton, K., Haynes, B., & Mathieu, A. (1994). Effects of Computer-based
Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A
Critical Appraisal of Research. Annals of Internal Medicine, 120(2), 135-142.
58
Karahanna, E., & Straub, D. W. (1999). The psychological origins of perceived usefulness
and ease-of-use. Information & Management, 35(4), 237-250.
Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005). Improving clinical
practice using clinical decision support systems: a systematic review of trials to identify
features critical to success. British Medical Journal, 330(7495).
Keen, & W., P. G. (1981). Value Analysis: Justifying Decision Support Systems. MIS
Quarterly, 5(1), 1-15.
Klein, K. J., & Sorra, J. S. (1996). The Challenge of Innovation Implementation. The
Academy of Management Review, 21(4), 1055-1080.
Lee, J., & Allaway, A. (2002). Effects of personal control on adoption of self-service
technology innovations. Journal of Services Marketing, 16(6), 553-572.
Lee, Y. (2006). An empirical investigation into factors influencing the adoption of an
e-learning system. Online Information Review, 30(5), 517-541.
Liker, J. K., & Sindi, A. A. (1997). User acceptance of expert systems: a test of the theory of
reasoned action. Journal of Engineering and Technology Management, 14(2), 147-173.
Liu, J., Wyatt, J. C., & Altman, D. G. (2006). Decision tools in health care: focus on the
problem, not the solution. Medical Informatics and Decision Making, 6(4).
Malhotra, Y., & Galletta, D. F. (1999). Extending the technology acceptance model to
account for social influence: theoretical bases and empirical validation. Paper presented
at the System Sciences, 1999. HICSS-32. Proceedings of the 32nd Annual Hawaii
International Conference, Hawaii.
Mathieson, K. (1991). Predicting User Intentions: Comparing the Technology Acceptance
Model with the Theory of Planned Behavior. Information Systems Research, 2(3),
173-191.
McCaffrey, M. J. (1992). Maintenance of expert systems: the upcoming challenge Managing
expert systems (pp. 262-284). Heshey,PA, USA: IGI Publishing.
Metaxiotis, K., & Psarras, J. (2003). Expert systems in business: applications and future
directions for the operations researcher. Industrial Management & Data Systems,
103(5), 361 - 368.
Moon, J.-W., & Kim, Y.-G. (2001). Extending the TAM for a World-Wide-Web context.
Information & Management, 38(4), 217-230.
Moore, G. C., & Benbasat, I. (1991). Development of an Instrument to Measure the
Perceptions of Adopting an Information Technology Innovation. Information Systems
Research, 2(3), 192-222.
Morton, M. S. S. (1978). Desicion Support Systems: An organizational Perspective: Addison
- Wesley.
59
Murray, E., Pollack, L., White, M., & Lo, B. (2007). Clinical decision-making: physicians'
preferences and experiences. BMC Family Practice, 8(10).
Newman-Toker, D. E., & Pronovost, P. J. (2009). Diagnostic Errors—The Next Frontier for
Patient Safety. Journal of the American Medical Association, 301(11), 1060 - 1062.
Nguyen, T. D., & Barrett, N. J. (2006). The adoption of the internet by export firms in
transitional markets. Asia Pacific Journal of Marketing and Logistics, 18(1), 29-42.
Orlikowski, W. J. (1992). The Duality of Technology: Rethinking the Concept of Technology
in Organizations. Organization Science, 3(3), 398-427.
Payne, T. H. (2000). Computer Decision Support Systems. Chest, 118(2), 47-52.
Phillips, L. A., Calantone, R., & Lee, M.-T. (1994). International Technology Adoption:
Behavior Structure, Demand Certainty and Culture. Journal of Business & Industrial
Marketing, 9(2), 16-28.
Plouffe, C. R., Hulland, J. S., & Vandenbosch, M. (2001). Research Report: Richness Versus
Parsimony in Modeling Technology Adoption Decisions--Understanding Merchant
Adoption of a Smart Card-Based Payment System. Information Systems Research,
12(2), 208-222.
Prümper, J. (1993). Software-Evaluation Based upon ISO 9241 Paper presented at the
Proceedings of the Vienna Conference on Human Computer Interaction.
Renaud, K., & Biljon, J. v. (2008, Oct 1). Predicting technology acceptance and adoption by
the elderly: a qualitative study. Paper presented at the Proceedings of the 2008 annual
research conference of the South African Institute of Computer Scientists and
Information Technologists on IT research in developing countries: riding the wave of
technology.
Roberts, P., & Henderson, R. (2000). Information technology acceptance in a sample of
government employees: a test of the technology acceptance model. Interacting with
Computers, 12(5), 427-443.
Rogers, E. M. (1983). Diffusion of Innovations. New York, NY: Free Press.
Schepers, J., & Wetzels, M. (2007). A meta-analysis of the technology acceptance model:
Investigating subjective norm and moderation effects. Information & Management,
44(1), 90-103.
Sittig, D. F., Krall, M. A., Dykstra, R. H., Russell, A., & Chin, H. L. (2006). A survey of
factors affecting clinician acceptance of clinical decision support. Medical Informatics
and Decision Making, 6(6).
Snead, K. C., & Harrell, A. M. (1994). An Application of Expectancy Theory to Explain a
Manager's Intention to Use a Decision Support System. Decision Sciences, 25(4),
499-510.
60
Stacey, D., Pomey, M.-P., O'Connor, A. M., & Graham, L. D. (2006). Adoption and
sustainability of decision support for patients facing health decisions: an implementation
case study in nursing. Implementation Science, 1(17).
Stoel, L., & Lee, K. H. (2003). Modeling the effect of experience on student acceptance of
Web-based courseware. Internet Research: Electronic Networking Applications and
Policy, 13(5), 364-374.
Subramanian, G. H., Yaverbaum, G. J., & Brandt, S. J. (1997). An empirical evaluation of
factors influencing expert systems effectiveness. Journal of System Software, 38(3),
255-261.
Suh, E., Diener, E., Oishi, S., & Triandis, H. (1998). The shifting basis of life satisfaction
judgments across cultures: Emotions versus norms. Journal of Personality and Social
Psychology, 74(2), 482-493.
Taylor, S., & Todd, P. (1995a). Assessing IT Usage: The Role of Prior Experience. MIS
Quarterly, 19(4), 561-570.
Taylor, S., & Todd, P. (1995b). Understanding Information Technology Usage: A Test of
Competing Models. Information Systems Research, 6(2), 144-176.
Teo, T. S. H., Lim, V. K. G., & Lai, R. Y. C. (1999). Intrinsic and extrinsic motivation in
Internet usage. Omega, 27(1), 25-37.
Thompson, R. L., Higgins, C. A., & Howell, J. M. (1991). Personal Computing: Toward a
Conceptual Model of Utilization. MIS Quarterly, 15(1), 125-143.
Thompson, R. L., Higgins, C. A., & Howell, J. M. (1994). Influence of experience on
personal computer utilization: testing a conceptual model. Journal of Management
Information Systems, 11(1), 167-187.
Timmor, Y., & Rymon, T. (2007). To do or not to do: the dilemma of technology-based
service improvement. Journal of Services Marketing, 21(2), 99-111.
Tornatzky, L. G., & Klein, K. J. (1982). Innovation Characteristics and Innovation Adoption
ImplementationA: Meta-Analysis of findings. IEEE Transactions on Engineering
Management, 29(1), 28-45.
Trivedi, M. H., Daly, E. J., Kern, J. K., Bruce D Grannemann, Sunderajan, P., & Claassen, C.
A. (2009). Barriers to implementation of a computerized decision support system for
depression: an observational report on lessons learned in "real world" clinical settings.
Medical Informatics and Decision Making, 9(6).
Turban, E. (1990). Decision Support and Expert Systems: Management Support Systems
(second ed.). New York: Macmillan Publishing.
Tyran, C. K., & George, J. F. (1993). The implementation of expert systems: a survey of
successful implementations. SIGMIS Database, 24(1), 5-15.
Van Raaij, E. M., & Schepers, J. J. L. (2008). The acceptance and use of a virtual learning
environment in China. Computers & Education, 50(3), 838-852.
61
Venkatesh, V. (1999). Creation of Favorable User Perceptions: Exploring the Role of
Intrinsic Motivation. MIS Quarterly, 23(2), 239-260.
Venkatesh, V., & Davis, F. D. (2000). A Theoretical Extension of the Technology
Acceptance Model: Four Longitudinal Field Studies. Management Science, 46(2),
186-204.
Venkatesh, V., Morris, M. G., & Ackerman, P. L. (2000). A Longitudinal Field Investigation
of Gender Differences in Individual Technology Adoption Decision-Making Processes.
Organizational Behavior and Human Decision Processes, 83(1), 33-60.
Venkatesh, V., Morris, M. G., Gordon, B. D., & Davis, F. D. (2003). User Acceptance of
Information Technology: Toward a Unified View. MIS Quarterly, 27(3), 425-478.
Wei, T. (2006). The causal relationship between technologies attributes. International
Journal of Management Science, 23(2), 782-793.
Wong, B. K., & Monaco, J. A. (1995). Expert system applications in business: A review and
analysis of the literature (1977-1993). Information & Management, 29(3), 141-152.
Wyatt, J., & Spiegelhalter, D. (1991). Field trials of medical decision-aids: potential problems
and solutions. Procedings of the Fifthteen Annual Symposium on Computer
Applicantions in Medical Care Whashington, DC. Journal of the American Medical
Informatics Association.