A Theory of Rural Telehealth Innovation - A Paradoxical Approach

Telehealth promises to provide underserved communities with better medical services and to help rural healthcare institutions become financially sustainable. However, these institutions find it challenging to implement telehealth because their resources are severely constrained even to maintain current operations. This paper investigates how a rural health institution successfully addressed this paradoxical situation by integrating telehealth into its operations over a 20-year period. We identify three sets of tensions that manifest during the telehealth implementation process: autonomy vs. dependence (relating to resource acquisition), controlling vs. drifting (relating to enabling the innovation), and exploration vs. exploitation (relating to creating a sustainable solution). Drawing on Poole and Van de Ven’s (1989) paradoxical approach, we develop four propositions comprising a theory of rural telehealth innovation. We suggest that three paradoxes shape rural telehealth innovation: Paradox of Alliance, Paradox of Governance, and Paradox of Learning, and explain how innovation unfolds in response to these paradoxes

DOES THE WINNER TAKE IT ALL? – TOWARDS AN UNDERSTANDING OF WHY THERE MIGHT BE NO ONE-SIZE-FITS-ALL GAMIFICATION DESIGN

Despite the popularity of gamification, and the positive effects of games in daily life, many gamification projects fail. A possible explanation for this observation is that most projects follow a one-size-fits-all approach without considering what the intended users really want. Closely related to this, most approaches focus on the integration of competitive game structures even though several mechanisms are available. This applies especially for the learning context of the study. Consequently, we aim to investigate the effectiveness of multiple gamification configurations based on different underlying motivational structures of users. To achieve our goal, we combine social comparison and social interdependence theory. This integration of theories helps to identify reward structures. They serve to analyze differences in user needs concerning their motivation to learn. We develop hypotheses that expose four different reward structures: autonomous, competitive, cooperative, and co-competitive. Our research-in-progress paper closes with an outline of an upcoming experiment. Once our research is completed, we expect to be able to better understand how differences in the users’ motivational structures influence their motivation in the context of learning, and how gamification configurations can be adapted based on a user’s underlying motivational structures

IT Infusion and its Performance Impacts: An Empirical Analysis of eProcurement in the Service Industry

This paper examines the infusion of e-procurement applications along two dimensions of usage – intensity and organizational acceptance – and tests the relationship between use and procurement performance. Drawing upon the resource-based view of the firm, this paper tests the relationship between select organizational resources and e-procurement infusion in the context of procurement of indirect materials and services. The research model is estimated with survey data obtained on 193 organizations from the service sector. Data are analyzed using structural equation modeling. The results suggest that while organizational integration and business knowledge of IT managers are significantly related to only organizational acceptance of e-procurement, procurement process readiness and organizational slack resources are related to both the dimensions of e-procurement infusion. Our results also show that both dimensions of e-procurement infusion are positively related to procurement performance while their interaction effect on performance is negative. Theoretical and practical implications of these results are discussed

Examining the Potential of Information Technology to Improve Public Insurance Application Processes: Enrollee Assessments from a Concurrent Mixed Method Analysis

Objective: To assess the perceived readiness of Medicaid and Children’s Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs. Methods: We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ2 analysis for comparisons across different groups of respondents. Results: A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers. Discussion: IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes. Conclusions: The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market

The Quest for National Digital Agility: Digital Responses to Covid-19 in Five Countries

Countries worldwide have employed different digital solutions to contain and cope with the Covid-19 pandemic. In this explorative case research, we examine national-level digital responses to the pandemic in four specific areas—tracking and tracing, health data reporting, teleconsultation, and vaccination mobilization—across five countries: China, Denmark, Germany, South Korea, and the U.S. Drawing on the notion of agility and digital infrastructures, our cross-case analysis unveils how the countries’ digital responses to the pandemic have been shaped by their national health system characteristics. In addition, we highlight how existing digital health infrastructures, regulatory adaptations, and industry collaborations fostered the alacrity with which nations responded to the pandemic. We define national-level digital agility as the ability of a nation to leverage digital infrastructure capabilities to address urgent societal challenges in a contextually appropriate way. Our key contribution is a model of this complex, but urgently needed concept containing five building blocks, each of which is a critical prerequisite to building such agility. Despite focusing on addressing the existing challenges of the ongoing Covid-19 pandemic, we believe that researchers and policymakers can also take pointers away from our framework to tackle other socio-environmental challenges

Essays in business-to-business commerce on the internet

textThis dissertation consists of two essays in business-to-business (B2B) commerce on the Internet. The first essay investigates the extent of Internet-based procurement of production goods in manufacturing firms. We examine Internet use in companies in both informational and transactional aspects of the procurement process. The theoretical model proposed in this essay incorporates different organizational, inter-organizational and external factors that explain the differences in Internet use across firms. Furthermore, the model also examines the impact of product characteristics on Internet use. The conceptualization used in this essay allows us to study Internet use in the entire procurement process, and to distinguish the impacts of antecedent factors on use in different aspects in the procurement process. Survey data obtained from 404 manufacturing firms support the proposed model, and illustrate an interesting combination of factors that determine the extent of Internet use in the two aspects. We find that while computerization of the procurement process and volume uncertainty impact Internet use in both informational and transactional aspects, trust impacts use in only the informational aspect and technological uncertainty influences use in only the transactional aspect. The second essay examines planned future participation in Internet-based business-to-business public markets by manufacturing firms. We develop a model to examine the extent of planned future participation in B2B markets from both short-term and long-term perspectives. We conceptualize perceived benefits and perceived risks as key mediating constructs through which all other exogenous constructs impact firm participation. While reinforcing the importance of factors investigated in the prior literature, the essay examines several factors that have not been studied in detail, such as adjustment costs and technological opportunism. Survey data collected from 273 manufacturing firms strongly support the proposed model. Our results suggest that the extent of short-term participation is strongly related to the extent of long-term participation. Perceived benefits are related to both short-term and long-term participation, but perceived risks are not related to short-term participation significantly. In addition, IT sophistication, adjustment costs and institutional pressure are significantly related to perceived benefits, adjustment costs are positively related to perceived risks and institutional pressure is negatively related to perceived risks.Managemen

Organizational Path Constitution in Technological Innovation: Evidence from Rural Telehealth

Path constitution theory has emerged as a promising combination of two contrasting perspectives on technological innovation: path dependence, which focuses on historically embedded, contingent processes that are more or less beyond the control of actors, and path creation, which emphasizes mindful contributions from powerful actors. However, the current path constitution literature focuses on macro- and multi-level inquiry without addressing the specific processes, opportunities, and challenges related to organizational (micro-level) technological innovation. Against this backdrop, we draw on the innovation and path literature as well as a case study of telehealth innovation in a public health organization to theorize how technological innovation paths constitute in organizational contexts. The proposed theory distinguishes between innovation path status and innovation path trajectory to help researchers understand and explain how organizations transform and reinforce path constitution patterns, how innovation paths may merge with or separate from other paths, and how organizations may arrive at a lock-in that challenges them to break out from dominant and seemingly irreversible action patterns

The Attraction Effect in Crowdfunding

At the core of reward-based crowdfunding (RBC) is the reward menu. Carefully constructed reward menus can impact fundraising success significantly. For example, an oft-discussed approach to influencing purchasing decisions is introducing an irrelevant option into a consumer's choice set-a decoy option-making another, often more valuable, option more attractive. This phenomenon is also known as the attraction effect. Prior research, however, has found mixed evidence for its occurrence in applied settings because it has largely employed simplified attribute presentation-with only numeric attributes such as ratings-and hypothetical choices, which had no economic consequences. Hence, researchers questioned the practical significance of the attraction effect. In this paper, we examine whether the attraction effect will manifest in an applied setting such as the crowd funding context, where product attributes are both numerical (e.g., price) and nonnumerical (e.g., content of a product), choices have economic consequences, and organizations offer several menu options to consumers. We draw upon the salience theory and propose four hypotheses, suggesting that introducing an irrelevant decoy option in choice sets, created digitally in reward menus, may lead backers to choose higher-priced options. We conducted seven online experiments and a field study on Kickstarter (in total, n = 3,998 participants), with increasing levels of similarity with RBC. We found that the attraction effect significantly shifted backers' preferences from a low-priced to a high-priced reward by 18.8% to 28.2% in different settings, highlighting the substantial potential of properly designed digital reward menus to influence funders' choices. Given that researchers have expressed skepticism about the attraction effect in applied settings, our results are particularly significant, suggesting that information systems design can influence choice behavior. This research makes targeted contributions to the literature on crowdfunding, the attraction effect, and digital design