While information systems researchers have argued well from socio-technical and organizational culture perspectives that information technology (IT) and organizational structures are interdependent and continually reshape each other, few studies have sought fine-grained, micro-level explanations for the heterogeneity in IT use often observed across seemingly similar end users and seemingly similar work contexts. Using a nested comparative case study design, I explore electronic medical record (EMR) use by physicians in an integrated multi-specialty health care organization. I use multiple methods to observe and develop micro-level understandings of factors associated with EMR use. The study was conducted in eight practices operating within the same organization. Data collection methods included semi-structured interviews, non-participant observations, and questionnaires. A constant comparative approach guided data analysis. Differences in physician values were noted, as were differences in physician perspectives of uncertainty. I categorized physicians as high, medium and low EMR users depending on a variety of factors including degree to which the EMR was integrated into work practices, degree of feature use, and degree of EMR-enabled communication. Drawing on theories of professionalism, I explain between-physician heterogeneity in EMR use as partly a function of differences in dimensionality of professional values. Three dimensions of professional values were identified 1) profession-oriented, 2) patient-oriented and 3) organization-oriented. Drawing on complexity theory, I argue that differences in physician perspectives of uncertainty influence their EMR use. I found that physicians who viewed uncertainty primarily as reducible through information tended to be higher users of the EMR. Physicians who viewed uncertainty as fundamental, or inherent, in care delivery processes tended to be lower users of the EMR. This study contributes to information systems research by extending current understandings of IT use. The professional values held by physicians and their perspectives of uncertainty may be more important in shaping EMR use than previously thought. These findings indicate the need to more aggressively pursue EMR designs, implementation strategies and policies that accommodate these two additional factors. Additionally, findings from this research indicate a need for IT managers in professional settings to consider end-user professional values and perspectives of uncertainty in decisions involving IT assets. / text

Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this research. Sixty-nine physician executives using either a Cerner Incorporated or Epic Systems EHR in a hospital or health system affiliated ACO participated in the online survey. The results of the regression analysis were statistically significant, R2 = .108, F(2,66) = 3.99, p = .023, indicating that characteristics of alert content and timing affect physician perceptions for improving their adherence to ACO quality measures. However, analysis of each independent variable showed alert content highly correlated with the dependent variable (p = .007) with no significant correlation found between workflow timing and the dependent variable (p = .724). Understanding the factors that support physician acceptance of alerts is essential to third-party software developers and health care organizations designing CDS tools. Providing physicians with improved EHR-integrated CDS tools supports the population health goal of ACOs in delivering better patient care.

Most leaders of healthcare delivery organizations have increased their rate of technological innovation, but some still struggle to keep pace with other industries. The problem addressed in this study was that senior leaders in some rural ambulatory healthcare facilities failed to innovate, even with recent healthcare technological innovations, which could lead to increased medical errors and a loss of efficiency. The purpose of the study was to examine if a relationship exists between the avoidance of technology threats by senior leaders in ambulatory healthcare organizations and the innovation propensity of the organization. Technology threat avoidance theory served as the theoretical basis for this correlational study. The research questions were used to investigate the relationship between technology threat avoidance by senior leaders and the ways avoidance affects an organization's level of technological innovation. Data were collected from 90 respondents via an anonymous online survey, developed from the innovation culture measurement and the COPE measurement, and analyzed using multiple regression and Spearman's correlation. Organizations with senior leaders who actively avoided technology threats had significantly higher innovation propensity (β = .51, p = .001). The analysis also showed that rural healthcare delivery organizations tended to have lower innovation propensity (β = -.18, p = .05). The study social change implications enable the leaders of more health care delivery organizations to actively mitigate technology threats, rather than passively avoiding them. Properly handling these threats could allow management to make more informed decisions about technology implementations and thus increase their ability to provide meaningful, innovative care and to avoid one of the leading causes of death-medical errors.