Pushing the contextual envelope: developing and diffusing IS theory for health information systems research

Radio frequency identification-enabled capabilities in a healthcare context: An exploratory study

Increasingly, the adoption and use of radio frequency identification systems in hospital settings is gaining prominence. However, despite the transformative impact that radio frequency identification has in healthcare settings, few studies have examined how and why this change may occur. The purpose of this study is to systematically understand how radio frequency identification can transform work practices in an operational process that directly impacts cost and operational efficiency and indirectly contributes to impacting patient safety and quality of care. We leverage an interdisciplinary framework to explore the contextual characteristics that shape the assimilation of radio frequency identification in healthcare settings. By linking the use of radio frequency identification with specific contextual dimensions in healthcare settings, we provide a data-driven account of how and why radio frequency identification can be useful in inventory management in this setting. In doing so, we also contribute to recent work by information systems scholars who argue for a reconfiguration of conventional assumptions regarding the role of technology in contemporary organizations.

Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation

INTRODUCTION

Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.

METHODS

A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.

RESULTS

The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.

DISCUSSION

Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Management attitudes and technology adoption in long-term care facilities

PURPOSE

The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT).

DESIGN/METHODOLOGY/APPROACH

This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators.

FINDINGS

This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT.

RESEARCH LIMITATIONS/IMPLICATIONS

Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research.

PRACTICAL IMPLICATIONS

This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance.

ORIGINALITY/VALUE

This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This finding has significant value for policy makers' practitioners for improving accessibility of information regarding the use of health IT in nursing homes that could address the health IT adoption challenge in this industry.

Perspectiva Institucional dos Sistemas de Informação em Saúde em Dois Estados Brasileiros

Os Sistemas de Informação em Saúde (SIS) são artefatos tecnológicos que respaldam gestores das três esferas governamentais a obter informações imprescindíveis para apoiarem a gestão e o planejamento do Sistema Único de Saúde (SUS). Neste estudo, foi escolhida a Teoria Institucional como lente teórica para analisar a incorporação de SIS na saúde pública brasileira, uma vez que pode existir uma influência direta do ambiente organizacional. Esta perspectiva possibilita encontrar explicações à influência dos fatores ambientais, sejam eles de cunho coercitivo, normativo ou mimético, no momento da decisão do uso de tecnologias em governos. O objetivo do artigo é verificar a influência desses fatores institucionais na utilização dos SIS pelas Secretarias Estaduais de Saúde (SES). Para atendimento do objetivo da pesquisa, optou-se por uma abordagem qualitativa, com estudos de casos múltiplos nas SES dos estados do Paraná e Rio Grande do Sul, tendo como unidade de análise o Sistema de Informações de Mortalidade (SIM) e o Sistema de Informações Hospitalares Descentralizado (SIHD). Com base no modelo conceitual proposto, foram apresentados diferentes fatores institucionais que influenciam na utilização dos referidos SIS, na forma de pressões coercitivas, miméticas e normativas.

Examining the potential of information technology to improve public insurance application processes: enrollee assessments from a concurrent mixed method analysis

OBJECTIVE

To assess the perceived readiness of Medicaid and Children's Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs.

METHODS

We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ(2) analysis for comparisons across different groups of respondents.

RESULTS

A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers.

DISCUSSION

IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes.

CONCLUSIONS

The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market.

National evaluation of the benefits and risks of greater structuring and coding of the electronic health record: exploratory qualitative investigation

OBJECTIVE

We aimed to explore stakeholder views, attitudes, needs, and expectations regarding likely benefits and risks resulting from increased structuring and coding of clinical information within electronic health records (EHRs).

MATERIALS AND METHODS

Qualitative investigation in primary and secondary care and research settings throughout the UK. Data were derived from interviews, expert discussion groups, observations, and relevant documents. Participants (n=70) included patients, healthcare professionals, health service commissioners, policy makers, managers, administrators, systems developers, researchers, and academics.

RESULTS

Four main themes arose from our data: variations in documentation practice; patient care benefits; secondary uses of information; and informing and involving patients. We observed a lack of guidelines, co-ordination, and dissemination of best practice relating to the design and use of information structures. While we identified immediate benefits for direct care and secondary analysis, many healthcare professionals did not see the relevance of structured and/or coded data to clinical practice. The potential for structured information to increase patient understanding of their diagnosis and treatment contrasted with concerns regarding the appropriateness of coded information for patients.

CONCLUSIONS

The design and development of EHRs requires the capture of narrative information to reflect patient/clinician communication and computable data for administration and research purposes. Increased structuring and/or coding of EHRs therefore offers both benefits and risks. Documentation standards within clinical guidelines are likely to encourage comprehensive, accurate processing of data. As data structures may impact upon clinician/patient interactions, new models of documentation may be necessary if EHRs are to be read and authored by patients.

Towards a Strategic Process Model of Governance for Agile IT Implementation: A Healthcare Information Technology Study in China

To remain competitive in the present dynamic environment, ‘governance for agility’ has become a key solution. Past literature paid little attention to understanding how governance for agility, particularly in regard to the delivery of Information Technology (IT) implementation. Using agile organisation and IT-governance theory as lenses to analyse data from a hospital case study, a strategic process model of governance for agility is empirically derived. This model suggests that agile healthcare information technology implementation is achievable via phase-based IT-governance strategies and forms which authorise decision makers to maneuver resources strategically in a dynamic environment. Theoretically, this study contributes to the dearth of empirical understanding of IT governance in the Healthcare IT literature and advances knowledge by making a conceptual distinction through introducing the use of phase-based IT-governance strategies and forms to generate agile organisational capabilities to achieve agile Healthcare IT implementation. The findings serve as a foundation for future research within the information systems (IS) discipline. Practitioners could plan an agile Healthcare IT implementation by referring to the model—a systematic roadmap for governing and strategising hospital resources and capabilities.

An investigation of the effect of nurses' technology readiness on the acceptance of mobile electronic medical record systems

BACKGROUND

Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses' bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses' personality traits in regard to technology readiness toward MEMR acceptance.

METHODS

The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data.

RESULTS

Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage.

CONCLUSIONS

Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses' requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses' work practices as these will also greatly enhance nurses' willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals should also include more employees' characteristics beyond socio-demographic profiles in their personnel databases.

Barriers to physicians' adoption of healthcare information technology: an empirical study on multiple hospitals

Prior research on technology usage had largely overlooked the issue of user resistance or barriers to technology acceptance. Prior research on the Electronic Medical Records had largely focused on technical issues but rarely on managerial issues. Such oversight prevented a better understanding of users' resistance to new technologies and the antecedents of technology rejection. Incorporating the enablers and the inhibitors of technology usage intention, this study explores physicians' reactions towards the electronic medical record. The main focus is on the barriers, perceived threat and perceived inequity. 115 physicians from 6 hospitals participated in the questionnaire survey. Structural Equation Modeling was employed to verify the measurement scale and research hypotheses. According to the results, perceived threat shows a direct and negative effect on perceived usefulness and behavioral intentions, as well as an indirect effect on behavioral intentions via perceived usefulness. Perceived inequity reveals a direct and positive effect on perceived threat, and it also shows a direct and negative effect on perceived usefulness. Besides, perceived inequity reveals an indirect effect on behavioral intentions via perceived usefulness with perceived threat as the inhibitor. The research finding presents a better insight into physicians' rejection and the antecedents of such outcome. For the healthcare industry understanding the factors contributing to physicians' technology acceptance is important as to ensure a smooth implementation of any new technology. The results of this study can also provide change managers reference to a smooth IT introduction into an organization. In addition, our proposed measurement scale can be applied as a diagnostic tool for them to better understand the status quo within their organizations and users' reactions to technology acceptance. By doing so, barriers to physicians' acceptance can be identified earlier and more effectively before leading to technology rejection.

Development of Trust During Large Scale System Implementation

Implementations of information systems are complex and problematic with a reputation for being delayed and exceeding budget. A critical factor in implementations is trust in the system, trust in the project and trust between the various stakeholders. This case charts the evolution of trust in the implementation of the Faroese integrated healthcare system and shows how trust relations at various points in the project became difficult, what the causes and consequences of these trust difficulties were, and how they were successfully resolved in the project.

The technology acceptance model: its past and its future in health care

Increasing interest in end users' reactions to health information technology (IT) has elevated the importance of theories that predict and explain health IT acceptance and use. This paper reviews the application of one such theory, the Technology Acceptance Model (TAM), to health care. We reviewed 16 data sets analyzed in over 20 studies of clinicians using health IT for patient care. Studies differed greatly in samples and settings, health ITs studied, research models, relationships tested, and construct operationalization. Certain TAM relationships were consistently found to be significant, whereas others were inconsistent. Several key relationships were infrequently assessed. Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications. Aside from improved study quality, standardization, and theoretically motivated additions to the model, an important future direction for TAM is to adapt the model specifically to the health care context, using beliefs elicitation methods.

Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?

The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.

Dialectics of Resilience: A Multi–Level Analysis of a Telehealth Innovation

Resilience is commonly portrayed as a positive capability that allows individuals, groups, and organizations to thrive in dynamic contexts. This paper questions this oversimplified view based on a dialectical analysis of a telehealth innovation within a network of collaborating hospitals. We analyze the major contradictions that characterize the adoption of the innovation. First, we analyze contradictions between individuals and groups within each adopting organization. Second, we analyze contradictions between the adopting organizations. This multi-level analysis leads to a deeper understanding of resilience as a dialectical process. The analysis of the case shows that, although the participating individuals, groups, and organizations demonstrated apparent resilience in adopting the telehealth innovation, the innovation remained in a fragile state, where it was unclear whether it would continue to diffuse, stabilize as-is, or slowly deteriorate. Hence, while resilience facilitated swift and successful adoption, it also created tensions that endangered further diffusion and the long-term sustainability of the telehealth innovation. We suggest that understanding the future success of the innovation would be facilitated to a large extent by a dialectical analysis of the involved contradictions.

Contextualizing usage research for interactive technology

E-Commerce technologies are interactive in nature, yet most research on E-Commerce adoption and use fails to consider this feature and the technology's social context of use in its theorizing. In this paper, we seek to theorize the technological feature of interactivity in a social context of information asymmetry by studying the use of E-Commerce technology among car sales associates in the US. Drawing on Social Exchange Theory (Kelley, 1979), we develop a model of interactive technology use that incorporates the user's beliefs about his/her exchange partner, the user's attitude toward technology use and the technology's perceived usefulness for the work process it is impacting. After refining our model with insights gained from observations of and interviews with a few car sales associates, we then test our contextualized model of E-Commerce use with data collected from a national survey of car sales associates (n=137).Our results show that attitude and users' beliefs about their exchange partners improve our ability to predict IT use. Furthermore, the contexualization of TAM highlights the theory's assumptions about the unemotional and individually-focused nature of users' decision making with respect to IT use.

The work to make telemedicine work: a social and articulative view

This article contends that the take up of telemedicine results inevitably in the reconfiguration of the existing work practices and socio-material relationships. This new way of working triggers a variety of shifts in coordination mechanisms, work processes and power relationships in the health care sector. The paper, which is based on the findings of a research project conducted in Northern Italy, addresses three critical issues of telemedicine: the conflict between the scripts embodied in telemedicine technologies and the daily work practices of heath care professionals; the tendency of telemedicine to produce a delegation of medical tasks to non-medical personnel (and to artifacts); and the tendency of telemedicine to modify the existing geography within the health care environment. The paper contends that telemedicine presupposes and entails some significant changes in work processes which affect both the material conditions of the expertise which is supposed to be distributed, and the relationships between health care professionals and their practices.