Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

The Knowledge Application and Utilization Framework Applied to Defense COTS: A Research Synthesis for Outsourced Innovation

Purpose -- Militaries of developing nations face increasing budget pressures, high operations tempo, a blitzing pace of technology, and adversaries that often meet or beat government capabilities using commercial off-the-shelf (COTS) technologies. The adoption of COTS products into defense acquisitions has been offered to help meet these challenges by essentially outsourcing new product development and innovation. This research summarizes extant research to develop a framework for managing the innovative and knowledge flows. Design/Methodology/Approach – A literature review of 62 sources was conducted with the objectives of identifying antecedents (barriers and facilitators) and consequences of COTS adoption. Findings – The DoD COTS literature predominantly consists of industry case studies, and there’s a strong need for further academically rigorous study. Extant rigorous research implicates the importance of the role of knowledge management to government innovative thinking that relies heavily on commercial suppliers. Research Limitations/Implications – Extant academically rigorous studies tend to depend on measures derived from work in information systems research, relying on user satisfaction as the outcome. Our findings indicate that user satisfaction has no relationship to COTS success; technically complex governmental purchases may be too distant from users or may have socio-economic goals that supersede user satisfaction. The knowledge acquisition and utilization framework worked well to explain the innovative process in COTS. Practical Implications – Where past research in the commercial context found technological knowledge to outweigh market knowledge in terms of importance, our research found the opposite. Managers either in government or marketing to government should be aware of the importance of market knowledge for defense COTS innovation, especially for commercial companies that work as system integrators. Originality/Value – From the literature emerged a framework of COTS product usage and a scale to measure COTS product appropriateness that should help to guide COTS product adoption decisions and to help manage COTS product implementations ex post

SMEs: ERP or virtual collaboration teams

Small firms are indeed the engines of global economic growth. Small and Medium Enterprises (SMEs) play an important role to promote economic development. SMEs in the beginning of implementing new technologies always face capital shortage and need technological assistance. Available ERP systems do not fulfil the specific requirements of Small firms. SMEs has scarce resources and manpower therefore many SMEs don?t have the possessions to buy and operate an ERP System. On the other hand competition and competitiveness of SMEs have to be strengthened. This paper briefly reviews the existing perspectives on virtual teams and their effect on SMEs management. It also discusses the main characteristics of virtual teams and clarifies the differences aspects of virtual team application in SMEs. After outlining some of the main advantages and pitfall of such teams, it concentrates on comparing of ERP and virtual collaborative teams in SMEs. Finally, it provides evidence for the need of ?Software as a Service (SaaS)? where an application is hosted as a service provided to customers across the web for SMEs as an alternative of ERP. It has been widely argued that ERP disadvantage in SMEs such as administrative expenditure and cost, isolated structure, severe lack of software flexibility, insufficient support of SMEs business and high operating cost, lead SMEs to use virtual collaborative team which is net work base solution

Investigating the impact of networking capability on firm innovation performance:using the resource-action-performance framework

The author's final peer reviewed version can be found by following the URI link. The Publisher's final version can be found by following the DOI link.Purpose The experience of successful firms has proven that one of the most important ways to promote co-learning and create successful networked innovations is the proper application of inter-organizational knowledge mechanisms. This study aims to use a resource-action-performance framework to open the black box on the relationship between networking capability and innovation performance. The research population embraces companies in the Iranian automotive industry. Design/methodology/approach Due to the latent nature of the variables studied, the required data are collected through a web-based cross-sectional survey. First, the content validity of the measurement tool is evaluated by experts. Then, a pre-test is conducted to assess the reliability of the measurement tool. All data are gathered by the Iranian Vehicle Manufacturers Association (IVMA) and Iranian Auto Parts Manufacturers Association (IAPMA) samples. The power analysis method and G*Power software are used to determine the sample size. Moreover, SmartPLS 3 and IBM SPSS 25 software are used for data analysis of the conceptual model and relating hypotheses. Findings The results of this study indicated that the relationships between networking capability, inter-organizational knowledge mechanisms and inter-organizational learning result in a self-reinforcing loop, with a marked impact on firm innovation performance. Originality/value Since there is little understanding of the interdependencies of networking capability, inter-organizational knowledge mechanisms, co-learning and their effect on firm innovation performance, most previous research studies have focused on only one or two of the above-mentioned variables. Thus, their cumulative effect has not examined yet. Looking at inter-organizational relationships from a network perspective and knowledge-based view (KBV), and to consider the simultaneous effect of knowledge mechanisms and learning as intermediary actions alongside, to consider the performance effect of the capability-building process, are the main advantages of this research

Integration of innovative users as source of service innovations

In this study we research user integration in the German service industry. Goal is to explore the industrial practice with regard to four dimensions of user integration, i.e., why, whom, how, and how successful the service industry integrates to find novel service ideas. Data is collected from a large-scale survey sent out to 2,905 service companies and posted in various user groups related to service innovations. Drawing from data gathered from 301 respondents in our study, we present explorative findings for each distinct dimension of user integration. To better understand the interrelation of these dimensions, we also create a structural equation model using partial least square for estimation of direction and strength of relationships between those. Results show that service companies like companies from other industries actively pursue the development of radical innovations. We find that service companies do not integrate users by random. Instead a service company's level of importance for radical innovation significantly determines both, choice of users integrated as well as choice of integration instruments deployed. In our study we can also show, that many of the beliefs brought forward by service companies for not integrating users cannot be sustained in the light of our findings. We can demonstrate that user contributions provide true value to those companies integrating the latter, and also that using tools which are considered easy and versatile to apply can still have a significant impact on the attractiveness of user ideas. --