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Appl Clin Inform 2012; 03(04): 488-500
DOI: 10.4338/ACI-2012-07-R-0029
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Schattauer GmbH

Drivers and Barriers in Health IT Adoption

A Proposed Framework
A.C. Avgar
1   School of Labor and Employment Relations and The College of Medicine, University of Illinois at Urbana Champaign, Champaign, IL
,
A.S. Litwin
2   The Johns Hopkins Carey Business School, Baltimore, MD
,
P.J. Pronovost
3   The Johns Hopkins University School of Medicine, Baltimore, MD
› Author Affiliations
Further Information

Publication History

Received 20 July 2012

Accepted 01 December 2012

Publication Date:
19 December 2017 (online)

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Summary

Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process – investment, implementation, and use – and at different levels of organizational decision-making – strategic, operational, and front-line. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems.

Citation: Avgar AC, Litwin AS, Pronovost PJ. Drivers and barriers in health IT adoption: A proposed framework. Appl Clin Inf 2012; 3: 488–500

http://dx.doi.org/10.4338/ACI-07-R-0029

Keywords

Health information technology - strategic choice - technology adoption - organizations
 

  • References

  • 1 Hillestead R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, and Taylor R. Can electronic medical record systems transform healthcare? Potential healthcare benefits, savings, and costs. Health Aff (Millwood) 2005; 24 (Suppl. 05) 1103-1117.
    CrossrefPubMedSearch in Google Scholar
  • 2 Shortliffe EH. Strategic action in health information technology: Why the obvious has taken so long. Health Aff (Millwood) 2005; 24 (Suppl. 05) 1222-1233.
    CrossrefPubMedSearch in Google Scholar
  • 3 DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, and Blumenthal D. Electronic health records in ambulatory care –a national survey of physicians. New Engl J Med 2008; 359: 50-60.
    CrossrefPubMedSearch in Google Scholar
  • 4 Wu S, Chaudhry B, Wang J, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Ann Inter Med 2009; 144 (10) 742-752.
    PubMedSearch in Google Scholar
  • 5 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: A review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30 (Suppl. 03) 464-471.
    CrossrefPubMedSearch in Google Scholar
  • 6 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in healthcare: An interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (Suppl. 05) 542-549.
    CrossrefPubMedSearch in Google Scholar
  • 7 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio R, Kimmel SE, and Strom BL. Role of computerized physician order entry systems in facilitating medication errors. JAMA-J Am Med Assoc 2005; 293 (10) 1197-1203.
    PubMedSearch in Google Scholar
  • 8 Jha AK. The promise of electronic records: Around the corner or down the road. J Am Med Assoc 2011; 306 (Suppl. 08) 880-881.
    PubMedSearch in Google Scholar
  • 9 Jha AK, DesRoches CM, Kralovec PD, Joshi MS. A progress report on electronic health records in US hospitals. Health Aff (Millwood) 2010; 29 (10) 1951-1957.
    CrossrefPubMedSearch in Google Scholar
  • 10 Litwin AS, Avgar AC, Pronovost P. Measurement error in performance studies of health information technology. Appl Clin Inf 2012; 3: 210-220.
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: A systematic review. J Am Med Inform Assoc 2005; 12 (Suppl. 05) 505-516.
    CrossrefPubMedSearch in Google Scholar
  • 12 Ash JS, Gorman PN, Seshadri V, Hersh WR. Computerized physician order entry in U. S. hospitals: results of a 2002 survey. J Am Med Inform Assoc 2004; 11 (Suppl. 02) 95-99.
    PubMedSearch in Google Scholar
  • 13 Avgar AC, Hitt L, Tambe P. The effects of organizational factors on healthcare IT adoption costs: Evidence from New York nursing homes. In Proceedings from the 43rd HICSS Annual Conference. 2010
    PubMedSearch in Google Scholar
  • 14 Avgar AC, Tabme P, Hitt L. Decoupled learning: Organizational learning during outsourced healthcare information technology implementations. Working Paper. 2012
    PubMedSearch in Google Scholar
  • 15 Litwin AS. Technological change at work: The impact of employee involvement on the effectiveness of health information technology. Ind Lab Relat Rev 2011; 64 (Suppl. 05) 868-888.
    PubMedSearch in Google Scholar
  • 16 Cooper RB, Zmud RW. Information technology implementation research: A technological diffusion approach. Manage Sci 1990; 36 (Suppl. 02) 123-139.
    CrossrefPubMedSearch in Google Scholar
  • 17 Batt RL. Work organization, technology, and performance in customer service and sales. Ind Lab Relat Rev. 1999; 52 (Suppl. 04) 539-64.
    CrossrefPubMedSearch in Google Scholar
  • 18 Kochan TA. On the human side of technology. ICL Tech 1988; 6 November 391-400.
    PubMedSearch in Google Scholar
  • 19 Bresnahan TF, Brynjolfsson E, Hitt LM. Information technology, workplace organization, and the demand for skilled labor: Firm level evidence. Q J Econ 2002; 117 (Suppl. 01) 339-376.
    CrossrefPubMedSearch in Google Scholar
  • 20 Brynjolfsson E, Hitt LM, Yang S. Intangible assets: Computers and organizational capital. Brookings Papers on Economic Activity 2002; 2002 (Suppl. 01) 137-181.
    CrossrefPubMedSearch in Google Scholar
  • 21 Boynton AC, Zmud RW, Jacobs GC. The influence of IT management practice on IT use in large organizations. MIS Quart 1994; 18 (Suppl. 03) 299-318.
    CrossrefPubMedSearch in Google Scholar
  • 22 Lewis W, Agarwal R, Sambamurthy V. Sources of influence on beliefs about information technology use: An empirical study of knowledge workers. MIS Quart 2003; 27 (Suppl. 04) 657-678.
    CrossrefPubMedSearch in Google Scholar
  • 23 Grover V, Teng J, Segars AH, Fiedler K. The influence of information technology diffusion and business process change on perceived productivity: The IS executive’s perspective. Inform Manage 1998; 34 (Suppl. 03) 141-159.
    CrossrefPubMedSearch in Google Scholar
  • 24 Sambamurthy V, Zmud R. Arrangements for information technology governance: A theory of multiple contingencies. MIS Quarter 1999; 23 (Suppl. 02) 261-290.
    PubMedSearch in Google Scholar
  • 25 Bartel A, Ichniowski C, Shaw K. How does information technology really affect productivity? Plant-level comparisons of product innovation, process improvement and worker skills. Q J Econ 2007; 122 (Suppl. 04) 1721-1758.
    CrossrefPubMedSearch in Google Scholar
  • 26 Brynjolffson E, Hitt LM. Beyond computation: Information technology, organizational transformation and business performance. J Econ Perspect 2000; 14 (Suppl. 04) 23-48.
    CrossrefPubMedSearch in Google Scholar
  • 27 Avgar AC, Kuruvilla S. Dual alignment of industrial relations activity: From strategic choice to mutual gains. Adv Ind Lab 2011; 18: 1-39.
    PubMedSearch in Google Scholar
  • 28 Kochan TA, McKersie R, Cappelli P. Strategic choice and industrial relations theory. Ind Relat 1984; 23 (Suppl. 01) 16-39.
    CrossrefPubMedSearch in Google Scholar
  • 29 Kochan TA, Katz H, McKersie R. The transformation of American industrial relations. 2nd ed. New York: ILR press; 1994
    Search in Google Scholar
  • 30 Barley SR. Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments. Adm Sci Q 1986; 31 (Suppl. 01) 78-108.
    CrossrefPubMedSearch in Google Scholar
  • 31 Avgar AC, Lipsky D. Caregivers and computers: Key lessons from the adoption and implementation of EMR in New York State nursing homes. Adv Ind Lab 2012; 20: 75-104.
    PubMedSearch in Google Scholar
  • 32 Lipsky DB, Avgar AC, Lamare J. Organizational strategies for the adoption of electronic medical records: Toward an understanding of outcome variation in nursing homes. Proceedings from the 61st Labor and Employment Relations Annual Meetings 2009.
    PubMed
  • 33 Simon HA. Models of man: Social and rational. Oxford, UK: Wiley; 1957
    Search in Google Scholar
  • 34 Simon HA. Reason in human Affair. Palo Alto, CA: Stanford University Press; 1990
    Search in Google Scholar
  • 35 Galbraith JR. Organization design: Information processing view. Interfaces 1974; 4 (Suppl. 03) 28-36.
    PubMedSearch in Google Scholar
  • 36 Avgar AC, Givan R, Liu M. Patient-centered, but employee delivered: Patient care innovation, turnover and organizational outcomes in hospitals. Ind Lab Relat Rev 2011; 64 (Suppl. 03) 423-440.
    CrossrefPubMedSearch in Google Scholar
  • 37 Davis KD, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Inter Med 2005; 20 (10) 953-957.
    CrossrefPubMedSearch in Google Scholar
  • 38 Edmondson AC, Bohmer R, Pisano GP. Dirupted routines: Team learning and new technology adaptation. Admin Sci Quart 2001; 46 (Suppl. 04) 685-716.
    CrossrefPubMedSearch in Google Scholar
  • 39 Pisano GP, Bohmer RMJ, Edmondson AC. Organizational differences in rates of learning: Evidence from the adoption of minimally invasive cardiac surgery. Management Sci 2001; 47 (Suppl. 06) 752-768.
    CrossrefPubMedSearch in Google Scholar
  • 40 Hayes LJ, O’Brien-Pallas L, Duffield C, Sharmian J, Buchan J, Hughes F, Laschinger HKS, North N, Stone PW. Nurse turnover: A literature review. Int J Nurs Stud 2006; 43 (Suppl. 02) 237-263.
    CrossrefPubMedSearch in Google Scholar
  • 41 Edmonson AC. Psychological safety and learning behavior in work teams. Admin Sci Quart 1999; 44 (Suppl. 02) 350-383.
    CrossrefPubMedSearch in Google Scholar
  • 42 Schein EH. Organizational culture. Am Psychol 1990; 45 (Suppl. 02) 109-119.
    CrossrefPubMedSearch in Google Scholar
  • 43 Wilkins AL, Ouchi WG. Efficient cultures: Exploring the relationship between culture and organizational performance. Org Sci 1983; 28 (Suppl. 03) 468-481.
    PubMedSearch in Google Scholar
  • 44 Argote L, Beckman SL, Eppel D. The persistence and transfer of learning in industrial settings. Management Sci 1991; 36 (Suppl. 02) 140-154.
    PubMedSearch in Google Scholar
  • 45 Argote L. Organizational learning: Creating, retaining and transferring knowledge. Boston: Kluwer Academic Publishers; 1999
    Search in Google Scholar
  • 46 Edmondson AC, Winslow AB, Bohmer RMJ, Pisano GP. Learning how and learning what: Effects of tacit and codified knowledge on performance improvement following technology adoption. Decision Sci 2003; 34 (Suppl. 02) 197-223.
    CrossrefPubMedSearch in Google Scholar
  • 47 Gittell JH. New directions for relational coordination theory. In: Cameron K, Spreitzer, G. editors. Oxford handbook of positive organizational scholarship Oxford: Oxford University Press; 2010
    Search in Google Scholar