Electronic health records (EHR) facilitate integration of patient health history for planning safe and proper treatment. Combined with data analytics, aggregate-level EHR enable examination and development of effective medicines and therapies for chronic diseases. Although promising efforts to implement EHRs are underway, social and organizational challenges plague EHR development and widespread use. These challenges are due to lingering issues such as privacy, interoperability, and security among key stakeholders (patients, providers, and purveyors). Based upon stakeholders' needs and the issues, we identify two primary thematic areasÑintegration and analyticsÑin which the information systems (IS) discipline can contribute to EHRs. Through the accumulated body of knowledge, IS researchers are well positioned and have the expertise to design, develop, and facilitate the use of EHR in the delivery of healthcare. We identify potential research opportunities in each of the two thematic areas that have the potential to transform the delivery of healthcare. We conclude with a recommendation for IS scholars to collaborate with allied healthcare disciplines in order to advance the use of EHR to improve patient care.
This study integrates tenets of the behavioral theory of the firm and neo-institutional theory to identify four recurring search mechanisms that are expected to influence hospital managers’ information systems investment decisions. To account for the critical role of regulation in healthcare, senior managers’ reliance on each of these four search mechanisms is hypothesized to be contingent upon their hospital’s regulative legitimacy. Analyses of panel data from all 153 public nonspecialist hospital organizations in England reveal that hospital managers invest in IS not only to find solutions to performance shortfalls (problemistic search), but also to achieve continuity and predictability in resource allocation (institutionalized search) and signal conformity with external norms and expectations (mimetic search). We find that the desire to make adequate use of uncommitted financial resources (slack search) is salient only among hospitals with low levels of regulative legitimacy. These new insights into the motives that trigger—and constrain—senior managers’ IS investment decisions will help IS managers to strengthen their case for IS investment and guide policy makers in how best to allocate resources to IS in healthcare and possibly beyond.
Prior studies on the business value of information technology (IT) mainly focus on the impact of IT investments on productivity and firm profitability. Few have considered its implication on expected and actual product or service quality. This paper fills this gap by investigating the impact of past healthcare IT (HIT) expenditure on the malpractice insurance premium (MIP) and the moderating effect of past HIT expenditure on the relationship between past MIP and current quality of patient care in a longitudinal model. Based on archival panel data on costs, operations, and patient care outcomes of 66 hospitals in the U.S. state of Washington from 1998 to 2007, we find that past HIT expenditure is negatively associated with MIP, supporting our argument that HIT provides value that is anticipated by insurers and is captured by a change in MIP. We find that past HIT is positively associated with quality of patient care. We also find that past MIP is positively associated with quality of patient care, supporting the premise that hospitals respond to MIP by making risk mitigation efforts. However, we find that past HIT moderates this relationship negatively, suggesting a reliance on HIT at the expense of risk mitigation.
Digital business strategies (DBS) offer significant opportunities for firms to enhance competitiveness. Unlike the large proprietary systems of the 1980s, today's "micro-applications" allow firms to create and reconfigure digital capabilities to appropriate short-term competitive advantage. In the quest to provide value to customers through digitization, such applications can be efficiently deployed. However, we propose that in the long-term not all digitization is desirable. Indiscriminate digital initiatives through the use of micro-applications by a firm could "reveal its hand" to competitors and erode competitiveness. We propose that a firm's DBS must balance its system-software, process, and information-visibility with the ability to appropriate value from such systems. Through a visibility-value framework, and examples drawn from practice, this article illustrates the tradeoffs involved in making these choices as the firm traverses a dynamic business environment. In doing so, it raises sensitivity to an important caveat in digital environments epitomized by hyper-competition and transparency.
Managers make informed information technology investment decisions when they are able to quantify how IT contributes to firm performance. While financial accounting measures inform IT's influence on retrospective firm performance, senior managers expect evidence of how IT influences prospective measures such as the firm's market value. We examine the efficacy of IT's influence on firm value combined with measures of financial performance for non-publicly traded (NPT) hospitals that lack conventional market-based measures. We gathered actual sale transactions for NPT hospitals in the United States to derive the q ratio, a measure of market value. Our findings indicate that the influence of IT investment on the firm is more pronounced and statistically significant on firm value than exclusively on the accounting performance measures. Specifically, we find that the impact of IT investment is not significant on return on assets (ROA) and operating income for the same set of hospitals. This research note contributes to research and practice by demonstrating that the overall impact of IT is better understood when accounting measures are complemented with the firm's market value. Such market valuation is also critical in merger and acquisition decisions, an activity that is likely to accelerate in the healthcare industry. Our findings provide hospitals, as well as other NPT firms, with insights into the impact of IT investment and a pragmatic approach to demonstrating IT's contribution to firm value.
Information systems have great potential to reduce healthcare costs and improve outcomes. The purpose of this special issue is to offer a forum for theory-driven research that explores the role of IS in the delivery of healthcare in its diverse organizational and regulatory settings. We identify six theoretically distinctive elements of the healthcare context and discuss how these elements increase the motivation for, and the salience of, the research results reported in the nine papers comprising this special issue. We also provide recommendations for future IS research focusing on the implications of technology-driven advances in three areas: social media, evidence-based medicine, and personalized medicine.
As business-to-consumer online shopping grows, e-commerce channel providers will need to explore ways to anticipate consumers' needs to deliver an efficient shopping experience. Yet the consumers' decision-making process and its relationship to the selection of the online channel are not well understood. Utilizing Simon's decision-making model, we examined support for decision-making phases using 134 online consumers. We also extended the model to include consumers' cost savings and time savings, as well as their satisfaction with the e-commerce channel. Structural equation modeling results indicate that the online shopping channel supported the overall decision-making process. In particular, we found strong support for the design and choice phases of online consumers' decision-making process. Our results also indicate that support for the decision-making process was mediated by the cost savings and time savings gained by the online consumers and led to their greater channel satisfaction.
Past literature recognizes the power of information technology (IT) to establish greater transparency and in turn the potential for greater control. Theoretical perspectives such as informating and agency theory describe situations whereby legitimized management authority can control goal divergence by implementing information systems to better monitor agents' behavior and outcomes. But what happens when the principal does not possess legitimacy to impose an agent's use of information and/or behavioral conformance? This study investigates this situation. Through an action research project, a physicians' profiling system (PPS) was used to monitor and benchmark physicians' clinical practices and outcomes resulting in changed practice behaviors in closer congruence with management's goals. The PPS project represents a successful attempt of a hospital's management (principal) to "informate the clan" of physicians (agents) to reduce clinical procedural costs and adopt practices benchmarked to produce better outcomes. This research moves beyond directly controlling informated workers through legitimized managerial authority to a better understanding of how to informate autonomous professionals. Emerging insights suggest that a clan can be informated if the principal can improve the perceived legitimacy of the information (the message), legitimize the technical messenger (customized user interface), legitimize the human messenger (boundary spanners and influential clan members), and facilitate an environment where clan-based discussion, using the information provided by the principal, is incorporated into the process of concertive control.
Payoffs from information technology (IT) continue to generate interest and debate both among academicians and practitioners. The extant literature cites inadequate sample size, lack of process orientation, and analysis methods among the reasons some studies have shown mixed results in establishing a relationship between IT investment and firm performance. In this paper we examine the structural variables that affect IT payoff through a meta-analysis of 66 firm-level empirical studies between 1990 and 2000. Employing logistic regression and discriminant analyses, we present statistical evidence of the characteristics that discriminate between IT payoff studies that observed a positive effect and those that did not. In addition, we conduct ordinary least squares (OLS) regression on a continuous measure of IT payoff to examine the influence of structural variables on the result of IT payoff studies. The results indicate that the sample size, data source (firm-level or secondary), and industry in which the study is conducted influence the likelihood of the study finding greater improvements on firm performance. The choice of the dependent variable(s) also appears to influence the outcome (although we did not find support for process-oriented measurement), the type of statistical analysis conducted, and whether the study adopted a cross-sectional or longitudinal design. Finally, we present implications of the findings and recommendations for future research.
Although electronic commerce (EC) has created new opportunities for businesses as well as consumers, questions about consumer attitudes toward Business-to-Consumer (B2C) e-commerce vis-a-vis the conventional shopping channels continue to persist. This paper reports results of a study that measured consumer satisfaction with the EC channel through constructs prescribed by three established frameworks, namely the Technology Acceptance Model (TAM), Transaction Cost Analysis (TCA), and Service Quality (SERVQUAL). Subjects purchased similar products through conventional as well as EC channels and reported their experiences in a survey after each transaction. Using constructs from the three frameworks, a model was constructed and tested to examine the determinants of the EC channel satisfaction and preference using the survey data. Structural equation model analyses indicate that metrics tested through each model provide a statistically significant explanation of the variation in the EC consumers' satisfaction and channel preference. The study found that TAM components--perceived ease of use and usefulness--are important in forming consumer attitudes and satisfaction with the EC channel. Ease of use also was found to be a significant determinant of satisfaction in TCA. The study found empirical support for the assurance dimension of SERVQUAL as determinant in EC channel satisfaction. Further, the study also found general support for consumer satisfaction as a determinant of channel preference.
With the enormous investments in Information Technology (IT), the question of payoffs from IT has become increasingly important. Organizations continue to question the benefits from IT investments especially in conjunction with corporate initiatives such as business process reengineering (BPR). Furthermore, the impact of technology on nonfinancial outcomes such as customer satisfaction and quality is gaining interest.