In this study, we examined physician acceptance behavior of the electronic medical record (EMR) exchange. Although several prior studies have focused on factors that affect the adoption or use of EMRs, empirical study that captures the success factors that encourage physicians to adopt the EMR exchange is limited. Therefore, drawing on institutional trust integrated with the decomposed theory of planned behavior (TPB) model, we propose a theoretical model to examine physician intentions of using the EMR exchange. A field survey was conducted in Taiwan to collect data from physicians. Structural equation modeling (SEM) using the partial least squares (PLS) method was employed to test the research model. The results showed that the usage intention of physicians is significantly influenced by 4 factors (i.e., attitude, subjective norm, perceived behavior control, and institutional trust). These 4 factors were assessed by their perceived usefulness and compatibility, facilitating conditions and self-efficacy, situational normality, and structural assurance, respectively. The results also indicated that institutional trust integrated with the decomposed TPB model provides an improved method for predicting physician intentions to use the EMR exchange. Finally, the implications of this study are discussed.