Ineffective deployment of mobile technology jeopardizes healthcare quality, cost control, and access, resulting in healthcare organizations losing customers and revenue. A multiple case study was conducted to explore the strategies that chief information officers (CIOs) used for the effective deployment of mobile technology in healthcare organizations. The study population consisted of 3 healthcare CIOs and 2 healthcare information technology consultants who have experience in deploying mobile technology in a healthcare organization in the United States. The conceptual framework that grounded the study was Wallace and Iyer's health information technology value hierarchy. Data were collected using semistructured interviews and document reviews, followed by within-case and cross-case analyses for triangulation and data saturation. Key themes that emerged from data analysis included the application of disruptive technology in healthcare, ownership and management of mobile health equipment, and cybersecurity. The healthcare CIOs and consultants emphasized their concern about the lack of cybersecurity in mobile technology. CIOs were reluctant to deploy the bring-your-own-device strategy in their organizations. The implications of this study for positive social change include the potential for healthcare CIOs to emphasize the business practice of supporting healthcare providers in using secure mobile equipment deployment strategies to provide enhanced care, safety, peace of mind, convenience, and ease of access to patients while controlling costs.

The Saudi ministry of health reported that government health care spending doubled from 2008 to 2011. To address increased demand, the government encouraged small to medium enterprise (SME) growth. However, SME leaders could not leverage technology as a growth enabler because they lacked strategies to address operating inefficiencies associated with technology. Only 50% of hospitals fully implemented information technology. The purpose of this phenomenological study was to explore lived experiences of SME leaders on strategies needed to accelerate technology implementation. This exploration drew on a conceptual framework developed from Wainwright and Waring's framework addressing issues of technology adoption. Data were collected from semistructured interviews of 20 SME leaders in Saudi Arabia. A modified van Kaam method was used to analyze participants' interview transcripts in search of common themes. The main themes were strategies to address human resources, clinical teams, funding, and organizational and leadership alignment to accelerate the diffusion of technology. Findings indicated that insurance companies influence SME operations, growth, and survival. Analysis of findings revealed the need for change in management, training, implementation follow up, and staff retention to accelerate technology implementation. Application of findings has the potential to promote positive social change in guiding SME leaders to be change agents and enabling them to create a reliable, sustainable health care delivery system.

The healthcare system in the US faces substantial challenges related to cost, access and quality. Health Information Exchange (HIE) has been widely viewed as a viable solution for dealing with those challenges. Despite the potential contributions to the healthcare system that HIE promises, adoption and use of HIE have always been difficult, and the past two decades have witnessed significant HIE implementation failures. The limited understanding of HIE is a major obstacle for HIE success. Only recently in-depth research about HIE starts to appear in top IS journals. In addition, the uniqueness of healthcare industry adds to the complexity to HIE. Our study attempts to address this research gap by systematically examining multiple factors that influence HIE adoption and use. Using social exchange theory (SET) and diffusion of innovations theory, a research model was developed to empirically test major factors that impact healthcare providers’ relative advantages and risks perceptions for adopting and using HIE. It is further proposed that relative advantages and risks in turn impact organizations’ intentions for adopting and continuously using HIE. As such, we posit that organizations’ assessments of relative advantages and risks associated with HIE mediate the impacts of organizational and technological factors on organizations’ adoption and use intentions. This study uses questionnaire surveys for data collection. Out of a total of 163 responses, 117 surveys were completed and were analyzed using Partial Least Square software SmartPLS 3. Data analysis finds that most of the relationships were in the hypothesized directions with some of the relationships being significant. Specifically, top management support, absorptive capacity, trust, and HIE innovation characteristics positively affect relative advantages and negatively affect risk. Furthermore, relative advantages positively affect adoption/continuance intentions, whereas risk negatively affects adoption/continuance intentions. This study contributes to the literature and offers important practical implications. It is one of the early empirical attempts to understand the key factors that affect HIE’s adoptions and use. The research can also serve as a starting point for more in-depth studies in the future. Moreover, practitioners can use the several newly-developed scales to empirically examine healthcare providers’ adoption and use intentions.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 292-306).

Electronic health records (EHRs) facilitate storing, organizing, and sharing personal health information. The academic literature suggests that multimedia information (MM; image, audio, and video files) should be incorporated into EHRs. We examined the acceptability of MM-enabled EHRs for Ontario-based software vendors and physicians, using a qualitative analysis of primary and acute care EHR vendor websites, and a survey of physician perceptions regarding MM features in EHRs. Primary care EHR vendors provided more product-specific information than acute care vendors; however, neither group emphasized MM features in their EHRs. Physicians had slightly positive perceptions of image and video features, but not of audio features. None of the external factors studied predicted physicians‘ intention to use MM. Our findings suggest that neither vendors nor physicians are enthusiastic about implementing or using MM in EHRs, despite acknowledging potential benefits. Further research is needed to explore how to incorporate MM into EHR systems.

Electronic health records (EHRs) facilitate storing, organizing, and sharing personal health information. The academic literature suggests that multimedia information (MM; image, audio, and video files) should be incorporated into EHRs. We examined the acceptability of MM-enabled EHRs for Ontario-based software vendors and physicians, using a qualitative analysis of primary and acute care EHR vendor websites, and a survey of physician perceptions regarding MM features in EHRs. Primary care EHR vendors provided more product-specific information than acute care vendors; however, neither group emphasized MM features in their EHRs. Physicians had slightly positive perceptions of image and video features, but not of audio features. None of the external factors studied predicted physicians‘ intention to use MM. Our findings suggest that neither vendors nor physicians are enthusiastic about implementing or using MM in EHRs, despite acknowledging potential benefits. Further research is needed to explore how to incorporate MM into EHR systems.

The IT artifact is at the core of the information systems (IS) discipline and yet most IS research does not directly theorize the IT artifact or its nomological network (Benbasat and Zmud 2003; Orlikowski and Iacono 2001). This research seeks to answer a repeated call for more direct engagement with the IT artifact and its nomological net with affordance theory adopted as the basis for this theoretical work. An exploratory case study was conducted to answer the research question, how do the material properties of health information systems enable and constrain the work practices of clinicians? The study was conducted at a large urban acute care hospital in the Midwestern United States with registered nurses working on inpatient care units as the clinicians of interest. Through interviews with nurses and other clinical stakeholders and the observation of nurse’s work practices on three patient care units in the hospital, theoretical insights were developed on the nature of affordances for information systems research. IS affordances are defined in this study as relationships between abilities of an individual and features of an information systems within the context of the environment in which they function. The concepts of an affordance range and an affordance threshold are proposed as theoretical constructs in the nomological network of affordances that help to explain the use of information systems as a function of the difficulty of acting on IS affordances. The relationship between affordances and constraints is theorized and linked to the affordance range and threshold with the assertion that constraints are closely associated with the difficulties experienced by users in acting on IS affordances. The challenge of studying IS affordances in all their complexity is discussed with the suggestion that researchers take the user’s perspective of affordances to alleviate the need for repeated decomposition. Finally, the role of information systems in facilitating social interaction is emphasized through the concept of affordances for sociality. The contribution of this research to the IS field is a more nuanced understanding of the nature of the IT artifact and its relationship to the users of that technology.

Abstract The 2009 American Recovery and Reinvestment Act has earmarked 27 billion dollars to promote the adoption of Health Information Technologies (HIT) in the US, and to gain access to these funds, providers must document “Meaningful Use” during the care process. While individual HIT use according to lean measures, including meaningful use, is prevalent in the IS literature, few studies have incorporated rich measures to account for the task, the technology, and the user in a team context. This dissertation conceptualizes Team Deep Structure Use of Computerized Provider Order Entry (CPOE) as an IT- enabled coordination mechanism, and Relational Coordination as the inherent ability of clinical teams to coordinate care spontaneously using informal, relationship based mechanisms. IT-enabled and Relational Coordination mechanisms are each evaluated across five maximally different patient conditions to simultaneously examine their impact on our outcome measure, Patient Satisfaction with the clinical care team. The extant literature has established a deep understanding of IT adoption shortly after implementation, yet the literature is silent on the antecedents of IT use according to rich measures well after the shake down phase, a period in which the majority of organizations operate. We incorporate the Adaptive Structuration Theory (AST) constructs of Faithfulness of Appropriation, and Consensus on Appropriation as the focal antecedents of Deep Structure Use of the clinical system by team members. To our knowledge, no prior research has linked these two AST constructs to clinical outcomes through the incorporation of a rich use mediator such as Deep Structure Use of a Health IT. To test our model, we relied on survey responses from 555 physicians, nurses and mid-levels which had cared for 261 patients across five patient conditions, ranging from vaginal birth, to organ transplant, as well as pneumonia, knee/hip replacement and cardiovascular surgery. Our results confirm that the Adaptive Structuration constructs of Faithfulness of Appropriation and Consensus on Appropriation, generate positive and statistically significant path coefficients predicting Team Deep Structure Use of CPOE. We also report differential effects on Patient Satisfaction with the care team resulting from technology use. Results range from a significant positive path coefficient (.285) associated with higher Team Deep Structure Use on combined Pneumonia and Organ Transplant teams, to a significant negative path coefficient (-.174) on cardiovascular surgery teams. As expected, Pneumonia, Organ Transplant and Cardiovascular Surgery teams all reported positive effects on Patient Satisfaction with the care team as a result of higher Relational Coordination scores. For teams caring for patient conditions consistently associated with a shorter length of stay, including vaginal birth and knee/hip replacement, higher reported use of IT- enabled, or Relational Coordination mechanisms, did not result in a significant increase in Patient Satisfaction. This dissertation contributes to the growing Health IT literature, and has practical implications for clinicians, hospital administrators and Health IT professionals. This dissertation is the first to operationalize a rich measure of use of an HIT by clinical teams, and to simultaneously measure the impact of IT enabled and Relational Coordination mechanisms on Patient Satisfaction. Secondly, through the introduction of Adaptive Structuration constructs, our model establishes a methodology for predicting rich, nuanced use in teams well after the initial shake down phase associated with recent HIT implementation. Through the juxtaposition of the impact of IT-enabled and Relational Coordination mechanisms across patient conditions, practitioners can design interventions and adjust the level of resources applied to process improvement accordingly.

BACKGROUND Integrated healthcare systems are believed to be enabled by the electronic exchange of clinical information. Canada and other national health systems are making substantial investments in information technology, in order to liberate and share clinical information between providers, improve the quality and safety of care, and reduce costs, yet we currently have no way of measuring these information flows, nor of understanding whether they contribute to the integration of care delivery. METHODS A literature review and consensus development process (nominal group) were used to provide guidance on system integration measures which are enabled by electronic information exchange. In order to conceptualize the components of electronic information exchange, establish a reference vocabulary for terminology, and guide the development of a questionnaire to gather field data, a formal ontology was developed. Validation of a sub-group of the survey data quality was achieved using the ontology and an unrelated database, demonstrating how ontologies may be used to adapt performance measurement methodologies to systems where constraints such as time-compression, lack of resources or access to needed information are prevalent. RESULTS The survey tool gathered cross-sectoral data from a regional health system which populated a summary measure of inter-provider electronic health information exchange (the eHIE), and measured perceptions of system integration from a single health region. The eHIE indicated that 7 -12% of clinical information that could be shared, was being shared electronically in the health region. ANOVA confirmed a significant correlation between the amount of information being exchanged electronically in this system and respondent perceptions of system integration suggesting that the eHIE may be used as a leading indicator for healthcare system integration. CONCLUSIONS It is possible to conceptualize and quantify inter-provider electronic health information exchange. As complex adaptive systems, healthcare systems are dynamic and open to correction; the use of a leading or proximal indicator such as the eHIE may inform effective policy-making and resource allocation in our pursuit of the goal of seamlessly integrated care.

<p><bold>Background:<bold> Hospital adoption of health information technology (HIT) systems is promoted as essential to decreasing medical error and their associated 44,000 annual deaths and $17 billion in healthcare costs (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 1999). Leading national healthcare groups, such as the Institute of Medicine, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, and the Leap Frog Group continue to advocate for increased use of HIT (AHRQ, 2010; Beidler, 2010; Institute of Medicine, 2001; Page, 2003; The Leapfrog Group, 2009), such as provider order entry and electronic health record systems, as a way to improve healthcare quality in hospitals. Even under intense pressure to adopt HIT, however, a mere 2% of US hospitals report having a comprehensive electronic health record system. Further, more than 50% of US hospitals have only rudimentary HIT systems (Jha et al., 2009). With the ARRA HITECH Act of 2009, the pressure on hospitals to quickly adopt HIT and achieve meaningful use is mounting.</p><p>While a large body of literature exists about HIT implementation, the majority is anecdotal case reports. The remaining studies investigated attitudes about HIT or the impact of HIT on patient care processes and outcomes. Thus, best strategies for implementing HIT in hospitals remain unknown. Study design choices, such as the use of self report data, retrospective data collection methods, subjects from single care units or single healthcare professions further limit our understanding HIT implementation in complex hospital care settings.</p><p><bold>Methods:<bold> This prospective, longitutdinal case study used a novel approach, sensemaking, to understanding how project teams may work to implement HIT in an academic medical center. Sensemaking, defined as the social process of establishing the meaning of events and experiences (Weick, 1995), is associated with learning and problemsolving in research studies of healthcare and nonhealthcare settings. Through direct observation and document review I observed project team social interaction and activities over the course of the 18 month preimplementation phase of an HIT implementation project in a single tertiary care hopsital.</p><p><bold>Conclusions:<bold> In this study, I described team actions and activities that enhanced clinician team member sensemaking including: frequent, collective interaction with HIT and focusing team members' attention on specific aspects of HIT function. Further, study findings demonstrated that team members' perceptions of HIT and care processes varied across healthcare professions, management levels, and departments. Supportive social interaction from team leaders and members encouraged team member participation and resulted in members' voicing observations, perceptions and attitudes about the HIT and hospital care processes. Sensemaking of HIT teams not only resulted in identification of needed HIT design changes, but also revealed assumptions and information which may prove critical to successful HIT implementation in hospital care environments. Based on study findings, I suggested strategies for selecting and preparing HIT team members as well as for HIT team activities. This study advanced our understanding of how project teams function and bring about change in complex hospital care environments by not only identifying HIT implementation issues within but also describing the link between team member social interaction and implementation actions.</p> / Dissertation