Information Systems and Healthcare XXXIII: An Institutional Theory Perspective on Physician Adoption of Electronic Health Records

With the recent legislation providing financial incentives to physicians who acquire electronic health record systems, we will be afforded an opportunity to study incentivized adoption of technology coupled with the threat of future penalties for non-adoption. This research uses institutional theory to propose factors that are expected to influence the adoption of electronic health records (EHRs) by independent physician practices in the coming years. The study presents a model describing the role of coercive, mimetic, and normative forces on adoption intent. Payer incentives/penalties as well as dominant healthcare delivery partners will exert coercive pressures on physician practices. Additionally, since physicians identify with their own specialties, it is expected that they will also be subject to mimetic forces resulting from successful adoption by similar specialists, particularly given their concerns about expected benefits from these systems. Finally, normative forces resulting from the successful interoperation of electronic health records among regional providers should influence physician adoption. The ability to partner with other physicians and healthcare providers or vendors adopting the same system should increase individual practice adoption intent in the presence of coercive, mimetic, and/or normative forces

Risk in Interorganizational Information Systems

This paper provides a framework for understanding the different types of interorganizational information sytsems and the risks that they pose. We suggest that the increased functionality and accessibility of information systems may require a new trust intermediary whose major role is to minimize competitiverisk, which is expected to be the major dimension of risk in future interorganizational information systems

Academic Departments of Information Systems Faculty in the U.S.

Information systems (IS) faculty are located in a variety of different departments in academic institutions. Both the theoretical basis of the discipline and the curricular needs of the professional business community influence departmental organization. Analyzing changes in the organizational home of information systems faculty in the 1980s and 1990s, we found that departmental structure did not reflect the establishment of IS as a fundamental theoretical discipline. The proportion of schools organizing information systems faculty in their own separate departments was relatively unchanged in 1995 compared to 1983, while the proportion of all IS faculty in separate IS departments decreased. There was no significant decrease in the proportion of IS faculty in departments of computer science and the proportion of faculty in management science departments and related fields increased through the mid 1990s. Changes in departmental location do reflect, however, the evolution of information systems in the business profession. There were significant increases in the proportion of schools and the number of faculty included with management, marketing, operations, interdisciplinary business, and finance departments and a significant decrease in accounting departments

Patients Are Not Simply Health IT Users or Consumers: The Case for “e Healthicant” Applications

Health IT applications today generally incorporate patients as passive users or consumers of information rather than active individuals who, in concert with their providers, are motivated and jointly responsible for their own good health. This article uses the healthcare value chain concept [Porter and Teisberg, 2006] as a framework to identify gaps in patient-centered e-health applications. While patient diversity poses challenges similar to consumer diversity for application design, consumer-centric design is limiting for patient-centered e-health because patients should not simply consume health care; they need to interact at multiple stages, alter their behaviors, and actively participate. This article raises critical research questions specific to this challenge. It defines a new term, “healthicant,” to motivate a research focus on technology-enabled applications that support individuals responsible for their own health and well-being, and who seek appropriate assistance as needed to prevent, diagnose, prepare, intervene, rehabilitate, monitor, and manage their health throughout their lifetime. The article contrasts the objectives of healthicants with both healthcare providers (for whom most health IT has been created) and more passive patients (for whom current “patient-centered” applications are evolving), in order to identify important gaps today. These include systems that support healthicant motivation, measurement, analysis, data mining, real-time personalized feedback, and multidirectional communication

Advocating for Action Design Research on IT Value Creation in Healthcare

Today there is mixed evidence that health IT decreases costs and/or improves care quality in the US. Some of the same factors that have driven delays in realizing the benefits from IT investments in other industries (i.e., time consuming process changes) are apparent in the U.S. healthcare industry, which is only now digitizing its fundamental patient data, the electronic health record. The healthcare industry itself is in transition and new IT may not provide full benefit unless it is accompanied with a restructuring of healthcare delivery. Traditional ex post approaches to measuring IT value will limit the ability of healthcare IT value researchers to add value to practice now especially as government incentives in the US drive significant investment. But generalizing results from traditional IT value research to the healthcare setting is risky due to differences between healthcare and other industries. I advocate for action design research that uses existing theory as a foundation, but adapts it to the specific unique characteristics of this industry. By actively participating in the design and evaluation of new socio-technical systems, IT value researchers can generate grounded theory to explain value creation in healthcare while influencing practice now

Information Systems in Academia: Where are the Faculty?

This paper takes an historical perspective and looks at the changes in the departmental home for the study of information systems from 1983 through 1995. The proportion of IS faculty located in autonomous IS departments decreased from 1983 to 1995. There was no significant change in the proportion of IS faculty in computer science and engineering departments while the proportion with management sciences and related fields increased from 1983 to 1989 but decreased slightly in the 1990s. There were significant increases in the proportion of IS faculty housed in primary value chain (management, marketing, operations), interdisciplinary, and finance departments and a significant decrease in accounting departments from 1983 to 1995. Departmental structure, therefore, did not reflect the establishment of IS as a fundamental theoretical discipline distinct from its reference disciplines. Changes in departmental structure did parallel the evolution of information systems use in business as the focus of information systems applications shifted from support to primary activities

The Risky Business of Managing Information Systems

IS managers are faced with many different risks such as project, capability, financial, and maintainability risks, caused by a variety of technical, organizational, and environmental factors. We found that senior IS managers in several diverse organizations focus primarily on managing organizational contributors to risk, in particular instituting various change management strategies to manage functionality and systems integration risk. Managers today are concerned about the financial risk resulting from lack of technical procedures to justify IS investments

A General, But Readily Adaptable Model of Information System Risk

This article is the first of two whose goal is to advance the discussion of IS risk by addressing limitations of the current IS risk literature. These limitations include: inconsistent or unclear definitions of risk, limited applicability of risk models, frequent omission of the temporal nature of risk, and lack of an easily communicated organizing framework for risk factors. This article presents a general, but broadly adaptable model of system-related risk. The companion article, (CAIS Volume 14, Article 2) focuses on IS risk factors and how these factors can be organized. This article starts by identifying criteria for a general, but broadly applicable risk model. It compares alternative conceptualizations of risk and provides clarifications of the definitions of risk and of different treatments of goals, expectations, and baselines for assessing risk. It presents several of the risk models in the IS literature and discusses the temporal nature of risk. Based on that background it presents a general and broadly adaptable model of risk that encompasses: goals and expectations, risk factors and other sources of uncertainty, the operation of the system or project whose risks are being managed, the risk management effort, the possible outcomes and their probabilities, impacts on other systems, and the resulting financial gains or losses. The model\u27s adaptability allows users to eliminate facets that are not important for their purposes. For example, the majority of current practitioners would probably think of risk in terms of negative outcomes rather than the full distribution of possible outcomes. A comparison of the general model with other risk models in the IS literature shows that it covers most of the ideas expressed by previous IS risk models while also providing a practical approach that managers can use for thinking about IS risk at whatever level of detail makes sense to them