The implementation of planned organizational change is ultimately a communication-related phenomenon, and as such, it is imperative that organizational communication scholars examine the interactions surrounding EHR implementation and understand how users (e.g. healthcare practitioners) utilize, evaluate, and deliberate this new technological innovation. Previous research on planned organizational change has called for researchers to adopt a more dynamic perspective that emphasizes the active agency of organizational members throughout implementation processes and focuses on informal implementers and change reinvention (work-arounds) as individuals actively reinterpret and personalize their work roles during implementation socialization. This dissertation seeks to fill this gap in research by demonstrating how communication between doctors, nurses, and other health professionals affects the adoption, maintenance, alternation, modification, or rejection of EHR systems within health care organizations. To delve into these inquiries and examine the intersecting domains of medical informatics and organizational communication research, this dissertation proceeds in the following manner: First, a literature review, capitalizing on Laurie Lewis’s work in planned organizational change and social constructionist views of technology use in organizations, outlines the assumptions that undergird this research. Next, this dissertation builds a model that predicts the communicative and structural antecedents of the study outcome variables, which include 1) organizational resistance to EHR implementation, 2) employees’ perception of EHR implementation success, 3) levels of change reinvention—or work-arounds—due to change initiatives and activities, and 4) employees’ perceptions of the quality of the organizational communication surrounding the change. Hypotheses guiding the model specification are provided and are followed by a description of the empirical methods and procedures that were utilized to explore the variable relationships. Results of the SEM model suggest that work-arounds could play a mediating role governing the relationship between informal social influence and the outcome variables in the study. In addition, one-way ANOVAs and multiple regression analyses reveal that physicians are the most resistant to EHR implementation and perceived change communication quality positively predicts perceived EHR implementation success and perceived relative advantage of EHR and negatively predicts employee resistance. A discussion of the expected and unexpected results is offered in addition to study limitation and future directions. / text

The current dissertation provides an examination of health information technology (HIT) by analyzing big datasets. It contains two separate essays focused on: (1) the evolving intellectual structure of the healthcare informatics (HI) and healthcare IT (HIT) scholarly communities, and (2) the impact of social support exchange embedded in social interactions on health promotion outcomes associated with online health community use. Overall, this dissertation extends current theories by applying a unique combination of methods (natural language processing, machine learning, social network analysis, and structural equation modeling etc.) to the analyses of primary datasets. The goal of the first study is to obtain a full understanding of the underlying dynamics of the intellectual structures of HI and its sub-discipline HIT. Using multiple statistical methods including citation and co-citation analysis, social network analysis (SNA), and latent semantic analysis (LSA), this essay shows how HIT research has emerged in IS journals and distinguished itself from the larger HI context. The research themes, intellectual leadership, cohesion of these themes and networks of researchers, and journal presence revealed in our longitudinal intellectual structure analyses foretell how, in particular, these HI and HIT fields have evolved to date and also how they could evolve in the future. Our findings identify which research streams are central (versus peripheral) and which are cohesive (as opposed to disparate). Suggestions for vibrant areas of future research emerge from our analysis. The second part of the dissertation focuses on comprehensively understanding the effect of social support exchange in online health communities on individual members’ health promotion outcomes. This study examines the effectiveness of online consumer-to-consumer social support exchange on health promotion outcomes via analyses of big health data. Based on previous research, we propose a conceptual framework which integrates social capital theory and social support theory in the context of online health communities and test it through a quantitative field study and multiple analyses of a big online health community dataset. Specifically, natural language processing and machine learning techniques are utilized to automate content analysis of digital trace data. This research not only extends current theories of social support exchange in online health communities, but also sheds light on the design and management of such communities.

Thesis advisor: John J. Michalczyk / The internet is changing health care right under out very noses. In doing so, it may have great impact on the physician-patient relationship. This relationship exists along a continuum, with paternalism at one end and total patient autonomy at the other. Various aspects of web-based health care (eHealth) are pushing the equilibrium one way or the other. Aspects of eHealth considered include: general health information websites, internet pharmacies, health communication infrastructures (as in physician-patient email and electronic medical records), and finally web-brokered organ transplantation. While there is obviously much to be aware of in terms of quality on the internet, it is concluded that an integration of eHealth into traditional medicine (thus creating cybermedicine) may not only help to mitigate the managed care crisis, but may also change the physician-patient relationship—hopefully for the better. / Thesis (BS) — Boston College, 2005. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program.

The population of older adults is growing worldwide, particularly in North America. Health information technology (HIT) is a group of technologies and systems that enhance care by electronically storing, managing, and exchanging data. HIT presents opportunities to support older adults' healthcare needs in communities and long-term care (LTC) environments. Despite their potential benefits, these technologies remain limited in LTC and older adults' healthcare contexts. Evidence is scattered on the factors that affect older adults' adoption of HIT. Little research has investigated the adoption of these technologies by formal healthcare providers and the technologies' impacts on LTC. A multi-method approach was employed in this thesis research, using a combination of a systematic qualitative review, an inductive semi-qualitative Delphi survey, and a quantitative deductive study to manage each research question in order to address these gaps. The systematic literature review used the PRISMA guidelines to identify and critically appraise studies that examined the effect of various HIT adoption factors among older adults in the community. The search involved five databases and a combination of keywords, resulting in the selection of critically appraised articles based on their evidence level and research rigor. A coding scheme was developed to extract information from the selected articles. The results showed that the main factors affecting HIT adoption by older adults relate to performance expectancy, effort expectancy, and high price/cost value. It also highlighted the importance of considering privacy/security and product design when evaluating HIT adoption by older adults. In light of the limited available studies on HIT adoption and impacts in the context of LTC, a Delphi study was developed to collect data from key formal healthcare providers (i.e., nurses) working in LTC at one of the largest and most progressive older adult healthcare facilities in Ontario, Canada. The Delphi study aimed to identify and prioritize the key factors that affect nurses' adoption of new technologies in support of older adults' care. A panel of nurses was solicited to participate in the Delphi study, which involved three rounds of data collection: brainstorming, narrowing down, and ranking. A total of 20 nurses completed the Delphi study, and the top factors that the LTC nurses identified were mainly related to the organizational and technological dimensions, including the complexity of HIT, the training and support provided, the interoperability of HIT systems, the cost of implementation, and the availability of HIT infrastructure. For the last part of this research, quantitative secondary data analysis was conducted on a Canadian national survey of nurses to examine their perceived impacts of HIT adoption by nurses in LTC. The survey included questions related to the current state of electronic medical records (EMR) and EMR adoption, the state of virtual care technologies, attitudes and perceptions related to access and the impact of the adoption of digital health technologies in practice, benefits and effects of EMR adoption, and barriers preventing nurses from getting total value from electronic health. A subset of 166 nursing homes/long-term care facilities/older adult residences and homecare nurses were selected for this analysis. Data management and analysis were conducted using IBM SPSS v28. The results showed that HIT adoption by nurses in LTC was positively associated with perceived benefits and organizational support. However, HIT adoption was negatively associated with perceived complexity and privacy/security concerns. This thesis research suggests that HIT adoption by older adults and nurses in LTC is complex and multifaceted, requiring attention to individual, organizational, and technological factors. There is a need for improved communication and collaboration among LTC team members and better working conditions to improve staff well-being and reduce turnover. The findings from the systematic review and Delphi study contribute to the theoretical understanding of the factors influencing the adoption of HIT in LTC facilities. The survey results provide valuable insights into the current state of HIT use in LTC facilities and can be used to inform the development of targeted interventions to improve HIT adoption and use. Overall, this study contributes to the growing body of knowledge on HIT adoption in LTC facilities and provides important recommendations for policymakers, administrators, and LTC staff to improve the use of HIT and ultimately enhance the quality of the care supplied to LTC residents.

Bakgrund: I Sverige pågår för närvarande stora projekt för att utforma och införa framtidens vårdinformationssystem. Dessa system utvecklas för att effektivisera hälso- och sjukvårdens processer och IT-miljöer. Elektroniska patientjournalsystem är den mest använda typen av vårdinformationssystem. Andra exempel är system för prover och svar, patientadministration och läkemedelsförskrivning. Trots att vårdinformationssystem har visat sig kunna bidra till ökad patientsäkerhet och kvalitet har implementering av nya system i hälso- och sjukvården en historia av att ofta misslyckas. Enligt ramverket Technology, People, Organizations and Macroenvironmental factors (TPOM), påverkar ett antal områden hur väl implementering av vårdinformationssystem faller ut.  Sjuksköterskor är den största legitimerade yrkeskåren inom hälso- och sjukvård. De ansvarar för omvårdnaden av en individ och hela dennes situation vilket bidrar till att sjuksköterskor är de som använder vårdinformationssystem mest frekvent. För att bidra till lyckad utveckling, implementering och förvaltning av vårdinformationssystem behöver sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation beskrivas.   Syfte: Studiens syfte är att beskriva sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation utifrån tekniska, personliga, organisatoriska och samhälleliga områden.  Metod: Kvalitativa semistrukturerade intervjuer genomfördes med tio legitimerade sjuksköterskor från olika verksamheter. Analys av insamlad data skedde genom kvalitativ innehållsanalys med deduktiv ansats utifrån huvudkategorierna i ramverket TPOM.  Resultat: Utmaningar och möjligheter inom områdena teknik, person, organisation och samhälle identifierades och beskrevs. Totalt tio subkategorier identifierades under huvudkategorierna. Respondenternas upplevelser av liknande utmaningar och möjligheter oavsett arbetsplats och vårdinformationssystem tyder på att resultatet kan appliceras och tas i beaktande vid utveckling, implementering och förvaltning oavsett vårdinformationssystem. / Background: Currently in Sweden, there are a number of ongoing extensive projects aiming towards development and adoption of futures’ health information technology (HIT). These systems are formed to make the processes and IT environment of health care more effective. Electronic health records are the most used type of health information technology. Other examples are systems for laboratory testing, patient administration and prescription of medications. Even though HIT has proven to contribute to effectiveness and quality of care, the implementations of such systems has a history of failing. According to the Technology, People, Organizations and Macroenvironmental factors framework (TPOM), a number of dimensions has an impact to determine the success of HIT implementation.  Nurses are the largest group of registered health care practitioners in Sweden. Nursing care include caring for the individual in whole, which leads to nurses extensive, and frequent use of HIT. To contribute to successful development, implementation and continuous management of HIT, nurses’ experiences of challenges and possibilities in HIT and documentation must be described further.  Aim: This study aims to describe nurses’ experiences of challenges and possibilities in Health information technology and documentation in the perspective of Technology, People, Organizations and Macroenvironmental factors.  Method: Qualitative, semistructured interviews was conducted with ten registered nurses coming from different types of care. Data was analyzed based on deductive approached qualitative content analysis, using the TPOM framework.  Results: Challenges and possibilites within technology, people, organizations and macroenvironmental domains were identified and described. A total of ten subcategories were identified. The respondendts experienced similar challenges and possibilites, regardless of workplace and health information technology. This implicates that the result of this study might be considered in development, implementation and management of HIT.