An organizational learning perspective on the assimilation of electronic medical records among small physician practices

A Methodology for Evaluating Operator Usage of Machine Learning Recommendations for Power Grid Contingency Analysis

This work presents the application of a methodology to measure domain expert trust and workload, elicit feedback, and understand the technological usability and impact when a machine learning assistant is introduced into contingency analysis for real-time power grid simulation. The goal of this framework is to rapidly collect and analyze a broad variety of human factors data in order to accelerate the development and evaluation loop for deploying machine learning applications. We describe our methodology and analysis, and we discuss insights gained from a pilot participant about the current usability state of an early technology readiness level (TRL) artificial neural network (ANN) recommender.

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review

Background

Electronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR.

Objective

This study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature.

Methods

PubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies.

Results

This systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification.

Conclusion

The most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

Building learning organizational culture during COVID-19 outbreak: a national study

Background

Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare system of the country. The present study aimed to examine the influence of several organizational learning dimensions on organization culture in healthcare settings during the COVID-19 outbreak.

Methods

During COVID-19 crisis in 2020, an online cross-sectional study was performed. Data were collected via official emails sent to 1500 healthcare professionals working in front line at four sets of hospitals in Saudi Arabia. Basic descriptive analysis was constructed to identify the variation between the four healthcare organizations. A multiple regression was employed to explore how hospitals can adopt learning process during pandemics, incorporating several Dimensions of Learning Organizations Questionnaire (DLOQ) developed by Marsick and Watkins (2003) and Leufvén and others (2015).

Results

Organizational learning including system connections (M = 3.745), embedded systems (M = 3.732), and team work and collaborations (M = 3.724) tended to have major significant relationships with building effective learning organization culture. Staff empowerment, dialogues and inquiry, internal learning culture, and continuous learning had the lowest effect on building health organization culture (M = 3.680, M = 3.3.679, M = 3.673, M = 3.663, respectively). A multiple linear regression was run to predict learning organization based on the several variables. These variables statistically significantly predicted learning organization, F (6, 1124) = 168.730, p < .0005, R² = 0.471, (p < .05).

Discussion

The findings concluded that although intrinsic factors like staff empowerment, dialogues and inquiry, and internal learning culture, revealed central roles, still the most crucial factors toward the development of learning organization culture were extrinsic ones including connections, embed system and collaborations.

Conclusions

Until knowledge-sharing is embedded in health organizational systems; organizations may not maintain a high level of learning during crisis.

Investigating Knowledge Flows between Information Systems and Other Disciplines:

Information systems (IS) is one of the most rapidly changing disciplines in the social science field, and it is currently facing a new academic shift. The prevailing concepts, such as big data and Internet of things (IoT), imply that there is a plethora of research opportunities for IS researchers. Since these opportunities lie mostly in conjunction with other disciplines closely related to IS, it is essential to identify the interaction between IS and those disciplines. A few studies using bibliometric analysis have been published regarding this topic. However, we have identified several limitations in them: (i) inclusion of only a small journal basket, (ii) focus on a very restricted area of discipline, and (iii) a methodological limitation that can lead to the failure to capture the authentic knowledge flow between IS and other disciplines. We attempt to extend previous studies by proposing a comprehensive analysis model with the largest journal basket and areas of disciplines. As a result of our analysis, a knowledge flow structure different from that of past research is identified. In addition, through the discussion on emerging reference disciplines, we discover new research opportunities into which IS researchers can delve.

A Meta-Analysis of Organizational Learning and IT Assimilation

Researchers often apply organizational learning concepts and theories to study what factors affect organizational IT assimilation. Although this body of work has substantially improved our understanding of the relationship between organizational learning and IT assimilation, to date there is no rigorous analysis of the empirical research that gives us an accurate assessment of what we truly know in this area. We meta-analyze 33 studies of organizational learning-based IT assimilation. While results show that an organization's level of related knowledge and knowledge diversity are both positively related to IT assimilation, moderator tests show that the consistency in these links varies depending upon the type of IT innovation studied and the way in which assimilation was conceptualized and measured. By narrowing the gap between what we know and what we need to know about the role of organizational learning during IT assimilation, this study contributes to our understanding of whether, when, and how organizations assimilate IT innovations.

Overcoming counter-knowledge through telemedicine communication technologies

Purpose Knowledge acquired from sources of unverified information such as gossip, partial truths or lies, in this paper it is termed as "counter-knowledge." The purpose of this paper is to explore this topic through an exploration of the links between a Hospital-in-the-Home Units (HHUs) learning process (LP), counter-knowledge, and the utilization of communication technologies. The following two questions are addressed: Does the reduction of counter-knowledge result in the utilization of communication technologies? Does the development of counter-knowledge hinder the LP? Design/methodology/approach This paper examines the relevance of communication technologies to the exploration and exploitation of knowledge for 252 patients of a (HHU) within a Spanish regional hospital. The data collected was analyzed using the PLS-Graph. Findings To HHU managers, this study offers a set of guidelines to assist in their gaining an understanding of the role of counter-knowledge in organizational LPs and the potential contribution of communication technologies. Our findings support the proposition that the negative effects of counter-knowledge can be mitigated by using communication technologies. Originality/value It is argued in this paper that counter-knowledge may play a variety of different roles in the implementation of LPs. Specifically, the assignment of communication technologies to homecare units has given them the means to filter counter-knowledge and prevent users from any possible problems caused by such counter-knowledge.

Evaluation of health information systems research in information systems research: A meta-analysis

Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000–2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the “Senior Scholars” list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.

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

Pervasive healthcare systems can reduce the costs and improve the quality of healthcare. However, insufficient care in managing the process before the organizational decision to adopt information technology (IT) can result in poor outcomes. With most previous research focusing on IT adoption, this paper develops a multi-stage theoretical framework for the pre-adoption phase of healthcare IT to address this practical challenge and gap in the literature. With a priori concepts identified from previous multi-stage models, our framework was developed by analyzing two cases of the introduction of vital signs monitoring systems in hospitals to identify the important stages and influencing factors for healthcare IT pre-adoption.

Organizational decision to adopt hospital information system: an empirical investigation in the case of Malaysian public hospitals

OBJECTIVES

This study mainly integrates the mature Technology-Organization-Environment (TOE) framework and recently developed Human-Organization-Technology (HOT) fit model to identify factors that affect the hospital decision in adopting Hospital Information System (HIS).

METHODS

Accordingly, a hybrid Multi-Criteria-Decision-Making (MCDM) model is used to address the dependence relationships of factors with the aid of Analytic Network Processes (ANP) and Decision Making Trial and Evaluation Laboratory (DEMATEL) approaches. The initial model of the study is designed by considering four main dimensions with 13 variables as organizational innovation adoption factors with respect to HIS. By using DEMATEL, the interdependencies strength among the dimensions and variables are tested. The ANP method is then adopted in order to determine the relative importance of the adoption factors, and is used to identify how these factors are weighted and prioritized by the public hospital professionals, who are wholly familiar with the HIS and have years of experience in decision making in hospitals' Information System (IS) department.

RESULTS

The results of this study indicate that from the experts' viewpoint "Perceived Technical Competence" is the most important factor in the Human dimension. In the Technology dimension, the experts agree that the "Relative Advantage" is more important in relation to the other factors. In the Organization dimension, "Hospital Size" is considered more important rather than others. And, in the Environment dimension, according to the experts judgment, "Government Policy" is the most important factor. The results of ANP survey from experts also reveal that the experts in the HIS field believed that these factors should not be overlooked by managers of hospitals and the adoption of HIS is more related to more consideration of these factors. In addition, from the results, it is found that the experts are more concerned about Environment and Technology for the adoption HIS.

CONCLUSIONS

The findings of this study make a novel contribution in the context of healthcare industry that is to improve the decision process of innovation in adoption stage and to help enhance more the diffusion of IS in the hospital setting, which by doing so, can provide plenty of profits to the patient community and the hospitals.

An Extended Perspective on Individual Security Behaviors

Security threats regularly affect users of home computers. As such, it is important to understand the practices of users for protecting their computers and networks, and to identify determinants of these practices. Several recent studies utilize Protection Motivation Theory (PMT) to explore these practices. However, these studies focus on one specific security protection behavior or on intentions to use a generic measure of security protection tools or techniques (practices). In contrast, this study empirically tests the effectiveness of PMT to explain a newly developed measure for collectively capturing several individual security practices. The results show that PMT explains an important portion of the variance in the unified security practices measure, and demonstrates the importance of explaining individual security practices as a whole as opposed to one particular behavior individually. Implications of the study for research and practice are discussed.

To Adopt or Not to Adopt

For several decades the information systems field has studied the individual-level decision to adopt Information Technology (IT) with the primary goal of making it easier for organizations to derive value out of IT by increasing their effective and efficient use of the deployed IT. While the topic of non-adoption has been discussed within the literature, the focus in previous work has been upon the perceptions of the individual towards the innovation (or a micro-level of analysis), neglecting the broader context within which the adoption/non-adoption decision takes place (or a macro-level of analysis). However, what about situations in which there is institutional pressure influencing an adoption decision? This paper posits that institutional pressure external to an organization may alter the directionality and outcome of the decision. This study adopts the Technology-Organization-Environment framework to examine the context of a physician's decision about whether or not to adopt Electronic Medical Record (or EMR) technology. It reports on a multiple state study within the United States that examines the technology, organization, and environmental factors that discriminate between adopters and non-adopters.

Network Effects in Health Information Exchange Growth

The importance of the Healthcare Information Exchange (HIE) in increasing healthcare quality and reducing risks and costs has led to greater interest in identifying factors that enhance adoption and meaningful use of HIE by healthcare providers. In this research we study the interlinked network effects between two different groups of physicians -- primary care physicians and specialists -- as significant factors in increasing the growth of each group in an exchange. An analytical model of interlinked and intragroup influences on adoption is developed using the Bass diffusion model as a basis. Adoption data on 1,060 different primary and secondary care physicians over 32 consecutive months was used to test the model. The results indicate not only the presence of interlinked effects, but also that their influence is stronger than that of the intragroup. Further, the influence of primary care physicians on specialists is stronger than that of specialists on primary care physicians. We also provide statistical evidence that the new model performs better than the conventional Bass model, and the assumptions of diffusion symmetry in the market are statistically valid. Together, the findings provide important guidelines on triggers that enhance the overall growth of HIE and potential marketing strategies for HIE services.

Improving quality of service of home healthcare units with health information technologies

Deployment of health information technologies (HITs) provides home care units with the means to generate improvements in accuracy and timeliness of information required to meet dynamic patient demands and provide high quality patient care. Increasing availability of information can also facilitate organisational learning, which leads to the invocation of processes that result in improved responses and decisions. This study examined crucial links between HITs and quality of service provided through an empirical investigation of 252 patients in a hospital-in-the-home unit (HHU) in a Spanish regional hospital. The study sought to test the relationship between HITs and the quality of service using factor analysis and structural equation modeling (SEM) to investigate how HITs mediate effects of organisational learning on quality of service. Findings support the notion that the relationship between organisational learning and quality of service can be mediated by HITs. This study provides HHU managers with guidelines for understanding the role of organisational learning processes with respect to HITs and quality of service.

Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

Background

The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.

Methods

A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information.

Results

The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers.

Conclusions

Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.

Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation

OBJECTIVES

(1) To assess expectations and experiences of a new eHealth service by patients and staff in three primary care settings; (2) to ascertain attitudes to a range of future, primary care-oriented eHealth services.

DESIGN

Qualitative case study.

SETTING

Three UK general practices introducing an eHealth service for booking patient appointments.

PARTICIPANTS

Ninety patients purposively selected from users and non-users of the new service and 28 staff (clinicians, management and administrative staff).

RESULTS

Actual patient use of the service was lower than stated intention. Patients and staff felt that more active promotion of the service would have resulted in more use. Low usage did not result in a negative assessment of the service by most staff. Different patient groupings were identified with characteristics that may be used as predictors of eHealth service use and indicators of training needs. GPs and patients expressed opposing viewpoints on a range of future eHealth services.

CONCLUSIONS

Take-up of eHealth services may be lower than expected. To overcome patient barriers, factors that may narrow the intention-behaviour gap such as level of service promotion, GP endorsement, and usage by different patient groups, should be investigated. For clinician barriers, the eHealth evidence base needs strengthening, while for primary care practices, a learning process including staff training needs to be instituted. The differing views of patients and GPs about components of eHealth means that policymakers need to plan for a lengthy political process to obtain agreement on contentious issues if they are to achieve successful eHealth services.

What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context

BACKGROUND

Given the current emphasis on networks as vehicles for innovation and change in health service delivery, the ability to conceptualize and measure organisational enablers for the social construction of knowledge merits attention. This study aimed to develop a composite tool to measure the organisational context for evidence-based practice (EBP) in healthcare.

METHODS

A structured search of the major healthcare and management databases for measurement tools from four domains: research utilisation (RU), research activity (RA), knowledge management (KM), and organisational learning (OL). Included studies were reports of the development or use of measurement tools that included organisational factors. Tools were appraised for face and content validity, plus development and testing methods. Measurement tool items were extracted, merged across the four domains, and categorised within a constructed framework describing the absorptive and receptive capacities of organisations.

RESULTS

Thirty measurement tools were identified and appraised. Eighteen tools from the four domains were selected for item extraction and analysis. The constructed framework consists of seven categories relating to three core organisational attributes of vision, leadership, and a learning culture, and four stages of knowledge need, acquisition of new knowledge, knowledge sharing, and knowledge use. Measurement tools from RA or RU domains had more items relating to the categories of leadership, and acquisition of new knowledge; while tools from KM or learning organisation domains had more items relating to vision, learning culture, knowledge need, and knowledge sharing. There was equal emphasis on knowledge use in the different domains.

CONCLUSION

If the translation of evidence into knowledge is viewed as socially mediated, tools to measure the organisational context of EBP in healthcare could be enhanced by consideration of related concepts from the organisational and management sciences. Comparison of measurement tools across domains suggests that there is scope within EBP for supplementing the current emphasis on human and technical resources to support information uptake and use by individuals. Consideration of measurement tools from the fields of KM and OL shows more content related to social mechanisms to facilitate knowledge recognition, translation, and transfer between individuals and groups.