Information Technology and Its Transformational Effect on the Health Care Industry

This dissertation examines the adoption of health IT by addressing the barriers to adoption from the perspective of multiple stakeholders. I examine three different phenomena using alternative methodologies and theoretical lenses. Essay 1: The Impact of Firm Characteristics and Spatial Proximity on the Diffusion of Electronic Medical Records: A Hazard Modeling Analysis. This study, positioned at the inter-organizational level, draws upon adoption and diffusion literature to predict the likelihood of EMR adoption by hospitals. I theorize that adoption is driven by factors such as the concentration and experience with complementary HIT and an environmental factor, spatial proximity. Using a hazard model fitted to data from a sample drawn from almost 4,000 hospitals, I find support for a positive relationship between IT concentration and likelihood of adoption. I also find that spatial proximity explains variance in adoption and that its effect diminishes as distance increases. Essay 2: Isolating the Effects of IT on Performance: An Empirical Test of Complementarities and Learning. An issue at the organizational level is whether benefits result from investment in HIT. I apply a knowledge-based lens to the examination of IT adoption and process-level value, incorporating the effects of learning occurring through complementary IT adoption. I test hypotheses using data from almost 400 nationally-representative hospitals matched with quality and financial performance data and find that learning associated with more experience with IT leads to superior performance. Essay 3: Adoption of Electronic Medical Records in the Presence of Privacy Concerns: The Elaboration Likelihood Model and Individual Persuasion. At the individual level, privacy concerns can inhibit the adoption of EMRs. I draw from literature on attitude change to develop hypotheses that individuals can be persuaded to support the use, and ultimately opt-in to EMRs, even in the presence of significant privacy concerns if compelling arguments about the value of EMRs are presented. Using a quasi-experimental methodology, I find that privacy concerns interact with argument framing and issue involvement to affect attitudes toward the use of EMRs. In addition, results suggest that attitude towards EMR use and CFIP directly impact the likelihood of adoption of EMR technology

A Tutorial on Empirical ICT4D Research in Developing Countries: Processes, Challenges, and Lessons

Humanitarian operations research holds a considerable allure for researchers, often promising interesting contexts to develop and extend current theory, large pools of data to validate theory and generate new insights, and, more generally, the opportunity to conduct “research that matters”. For many of these reasons, we embarked on several research initiatives over the past several years with mixed results. In this tutorial, we draw on several studies (some abandoned) to explore the use of information and communication technologies for humanitarian purposes, and we synthesize and highlight the distinct features of humanitarian operations research. Specifically, we draw attention to differences between “the process” of conducting these studies relative to traditional research and focus on challenges and opportunities for researchers

Adoption of Electronic Health Records in the Presence of Privacy Concerns: The Elaboration Likelihood Model and Individual Persuasion

Within the emerging context of the digitization of health care, electronic health records (EHRs) constitute a significant technological advance in the way medical information is stored, communicated, and processed by the multiple parties involved in health care delivery. However, in spite of the anticipated value potential of this technology, there is widespread concern that consumer privacy issues may impede its diffusion. In this study, we pose the question: Can individuals be persuaded to change their attitudes and opt-in behavioral intentions toward EHRs, and allow their medical information to be digitized even in the presence of significant privacy concerns? To investigate this question, we integrate an individual’s concern for information privacy (CFIP) with the elaboration likelihood model (ELM) to examine attitude change and likelihood of opting-in to an EHR system. We theorize that issue involvement and argument framing interact to influence attitude change, and that concern for information privacy further moderates the effects of these variables. We also propose that likelihood of adoption is driven by concern for information privacy and attitude. We test our predictions using an experiment with 366 subjects where we manipulate the framing of the arguments supporting EHRs. We find that an individual’s CFIP interacts with argument framing and issue involvement to affect attitudes toward the use of EHRs. In addition, results suggest that attitude toward EHR use and CFIP directly influence opt-in behavioral intentions. An important finding for both theory and practice is that even when people have high concerns for privacy, their attitudes can be positively altered with appropriate message framing. These results as well as other theoretical and practical implications are discussed

Race and Gender Bias in Online Ratings: An Origins Story

The digitization of commerce has provided both a mechanism by which goods and services are exchanged, as well as an efficient way for consumers to voice concerns, in the form of online rating systems. Yet, recent work has begun to uncover biases that manifest during the feedback process. In this work, we build upon research that has identified race and gender biases in online transactions, and probe the mechanisms by which such biases may manifest. Using an experimental methodology, we find little evidence of bias across race and gender when information about historical quality is available. Moreover, in the presence of a high quality experience, we find no differences in ratings based on race or gender. However, when quality is poor, worse ratings accrue for African Americans and females, notably when they are rated by white men, suggesting that bias may manifest because of errors of attribution

The Value of Centralized IT in Building Resilience During Crises: Evidence from U.S. Higher Education’s Transition to Emergency Remote Teaching

The COVID-19 pandemic forced organizations, including higher education institutions, to rapidly adjust their operations. In the face of the pandemic, most higher education institutions shut down their campuses and transitioned to emergency remote teaching mode. This study examines digital resilience in higher education institutions through the conceptual lens of disaster response management, by assessing the role played by the centralized governance of information technology (IT) investments. We posit that centralized IT helps organizations maintain customer satisfaction with services during a crisis (e.g., student satisfaction with classes during COVID-19) by facilitating the organization-wide transition to an emergency operational mode and supporting its service operations. Consolidating data on IT investment, governance, and course evaluations from 463 U.S. higher education institutions from 2017-2020, we show that centralized IT helped organizations adapt better to the pandemic in terms of maintaining student satisfaction. Moreover, we found that centralized IT investments geared toward facilitating organizational coordination and providing instructional and technical support played a pivotal role in enabling ERT and improving student ratings during the crisis. These results are corroborated by interviews with CIOs of U.S. higher education institutions. Additional analyses also suggest that the effectiveness of centralized IT governance is contingent upon organizational size, dissimilarity of local units, and the strategic role of the CIO. We also discuss theoretical extensions toward digital resilience as well as practical implications

Antecedents of Information Systems Sourcing Strategies in U.S. Hospitals: A Longitudinal Study

The popular press has long used the terms single-sourcing and multisourcing (also known as best of breed) to describe organizations’ sourcing strategies. Whereas there is an implicit understanding of these terms, no research has quantified what distinguishes one sourcing configuration from another or what institutional factors contribute to the pursuit of one strategy over the other. We leverage institutional theory to examine how key organizational antecedents such as strategic orientation (mission), formal structure (size), and internal dynamics (patient case mix complexity) influence the rate at which organizations move toward or away from a single-sourcing configuration. Employing longitudinal modeling combined with sequence analysis techniques, we empirically evaluate IS sourcing strategies of nearly all U.S. hospitals operating continuously over a 9-year time frame from 2005 to 2013. We find that hospitals are generally trending toward a single-sourcing configuration and that formal structure and internal dynamics serve as predictors of this trend. Contrary to the predictions of institutional theory, we find that strategic orientation is not predictive of IS sourcing strategy. These results have important implications for research and practice. Notably, we are the first to quantify sourcing strategies, and, by doing so, are able to inform practitioners and academics of the key organizational characteristics that lead hospitals to move more quickly toward single-sourcing configurations

Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in U.S. Hospitals

We use a social contagion lens to study the dynamic, temporal process of the diffusion of electronic medical records in the population of U.S. hospitals. Social contagion acknowledges the mutual influence among organizations within an institutional field and implicates information transmission through direct contact and observation as the mechanisms underlying influence transfer. We propose hypotheses predicting a hospital's likelihood of adopting electronic medical records as a function of its susceptibility to the influence of prior adopters, the infectiousness or potency of influence exerted by adopting hospitals, and its social and spatial proximity to prior adopters. Results obtained by fitting a heterogeneous diffusion model to data from a sample drawn from an annual survey, spanning 1975 to 2005, of almost 4,000 U.S. hospitals suggest that diffusion can be accelerated if specific attention is given to increasing social contagion effects. In particular, with respect to susceptibility to influence, greater hospital size and age are positively related to the likelihood of adoption for nonadopters, whereas younger hospitals are associated with greater infectiousness for adopters. A hospital's "celebrity" status also contributes to its infectiousness. We further find strong effects for social proximity and significant regional effects for spatial proximity and hospital size, suggesting that geographical covariates should be included in diffusion studies. Results also reinforce the importance of theorizing about and including interactions in examinations of social contagion.electronic medical record, diffusion, social contagion, propensity, susceptibility, infectiousness, spatial and social proximity

Electronic Health Records Assimilation and Physician Identity Evolution: An Identity Theory Perspective

With the lack of timely and relevant patient information at the point of care increasingly being linked to adverse medical outcomes, effective management and exchange of patient data has emerged as a strategic imperative for the healthcare industry. Healthcare informaticians have suggested that electronic health record systems (EHRS) can facilitate information sharing within and between healthcare stakeholders such as physician practices, hospitals, insurance companies, and laboratories. We examine the assimilation of EHRS in physician practices through a novel and understudied theoretical lens of physicians' identities. Physician practices and the physicians that lead them occupy a central position in the healthcare value chain and possess a number of unique characteristics that differentiate them from other institutional contexts, including a strong sense of affiliation with other physicians, potent professional identities, and a desire for autonomy. We investigate two salient physician identities, those of careprovider and physician community, grounded in the roles physicians play and the groups with which they affiliate. We argue that these identities and their evolution, triggered by EHRS, manifest as both identity reinforcement and deterioration, and are important drivers of EHRS assimilation. We use survey data from 206 physician practices, spread across the United States, to test our theoretical model. Results suggest that physician community identity reinforcement and physician community identity deterioration directly influence the assimilation of EHRS. We further find that the effects of careprovider identity reinforcement and careprovider identity deterioration on EHRS assimilation are moderated by governmental influence. Theoretical and pragmatic implications of the findings are discussed.This accepted article is published as Mishra, A. N., C. Anderson, C. M. Angst, R. Agarwal. 2012. Electronic health records assimilation and physician identity evolution: An identity theory perspective. Information Systems Research. (23:3, Part 1 of 2) 738-760. https://pubsonline.informs.org/doi/abs/10.1287/isre.1110.0407. Posted with permission