Examining the pre-adoption stages of healthcare IT: A case study of vital signs monitoring systems

Understanding and managing knowledge transfer for customers in IT adoption

Purpose

The purpose of this paper is to advance information technology (IT) adoption research and practice by investigating the process of knowledge transfer (KT) undertaken by suppliers of IT innovations. The authors expound the intricacies of formal and informal mechanisms of the KT initiative that aims at augmenting the absorptive capacity (ACAP) of potential IT adopters with the objective of increasing the likelihood of adoption of new IT products or services.

Design/methodology/approach

The authors draw on case studies of ten IT suppliers to build on the limited research on KT for customers in IT adoption. The authors focus on the for customer type of KT from the standpoint of the IT supplier firm.

Findings

The authors’ results show that complexity of the IT product or service increases the reliance on formal and systematic KT initiatives. This paper also shows that there is a required minimum threshold level of initial customers’ ACAP in order for the KT initiative to be worthwhile for the supplier, especially for those offering complex IT products and services. However, IT suppliers were found to limit their reliance on KT when they believed that customers that became too knowledgeable might threaten the innovation’s diffusion.

Research limitations/implications

Since the authors’ case firms represented innovation suppliers, future studies should investigate customer-supplier dyads to explore and integrate the customer’s perspective in the analysis of the KT process. To this end, longitudinal studies would also provide immense insights into the KT process and how it evolves over time.

Originality/value

The main contribution of this paper consists of illuminating the workings of KT initiatives aimed at existing and potential customers from the standpoint of the IT innovation supplier. By focusing on the for customers aspect of KT, this paper advances the authors’ understanding of why and how IT suppliers should resort to formal vs informal KT mechanisms. The authors’ proposed framework also integrates and shows the roles of customers’ ACAP, complexity of the IT innovation, and tacitness of the knowledge transferred to the customers.

Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices

BACKGROUND

There has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians' progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a "tiered ceiling effect" and then we show why such phenomenon occurs.

METHODS

We conducted in-depth case studies in three primary care medical practices in Canada where physicians had been using EMR systems for 3 years or more. A total of 37 semi-structured interviews were conducted with key informants: family physicians (about half of the interviews), nurses, secretaries, and administrative managers. Additional information was obtained through notes taken during observations of users interacting with their EMR systems and consultation of relevant documents at each site. We used abductive reasoning to infer explanations of the observed phenomenon by going back and forth between the case data and conceptual insights.

RESULTS

Our analysis shows that a ceiling effect has taken place in the three clinics. We identified a set of conditions preventing the users from overcoming the ceiling. In adopting an EMR system, all three clinics essentially sought improved operational efficiency. This had an influence on the criteria used to assess the systems available on the market and eventually led to the adoption of a system that met the specified criteria without being optimal. Later, training sessions focussed on basic functionalities that minimally disturbed physicians' habits while helping their medical practices become more efficient. Satisfied with the outcome of their system use, physicians were likely to ignore more advanced EMR system functionalities. This was because their knowledge about EMR systems came almost exclusively from a single source of information: their EMR system vendors. This knowledge took the form of interpretations of what the innovation was (know-what), with little consideration of the rationales for innovation adoption (know-why) or hands-on strategies for adopting, implementing and assimilating the innovation in the organization (know-how).

CONCLUSIONS

This paper provides a holistic view of the technological innovation process in primary care and contends that limited learning, satisficing behaviours and organizational inertia are important factors leading to the ceiling effect frequently experienced in the EMR system assimilation phase.