Aaron Baird

Associating consumer perceived value with business models for digital services

As digital services increasingly deal with commodity offerings (i.e., digital content and features that are similar between service providers), service providers are seeking to differentiate themselves with variations in their digital service business models. Research, though, has yet to consider the association of consumer perceived value with digital service business models underlying technological innovations. We seek to demonstrate that consumer value for digital service business models may be quite different even when consumers have similar preferences for standard technology characteristics. In the context of this paper, we specifically consider consumer perceived value associated with Personal Health Records (PHRs) and PHR digital business models, through the use of an integrated latent variable and choice empirical model. We find that although consumer perceived value for PHRs is generally high, when offered a choice between three competing PHR business models, consumers state high value for only two of the business models in the choice set: PHRs offered directly by groups of medical providers and Integrated PHRs. These findings suggest that while perceived value may be high for generally considered digital services, variations in the underlying digital service business models are likely to have significant impacts on consumer valuations of digital services.

Corporate governance and the adoption of health information technology within integrated delivery systems.

Background: Although several previous studies have found “system affiliation” to be a significant and positive predictor of health information technology (IT) adoption, little is known about the association between corporate governance practices and adoption of IT within U.S. integrated delivery systems (IDSs). Purposes: Rooted in agency theory and corporate governance research, this study examines the association between corporate governance practices (centralization of IT decision rights and strategic alignment between business and IT strategy) and IT adoption, standardization, and innovation within IDSs. Methodology/Approach: Cross-sectional, retrospective analyses using data from the 2011 Health Information and Management Systems Society Analytics Database on adoption within IDSs (N = 485) is used to analyze the correlation between two corporate governance constructs (centralization of IT decision rights and strategic alignment) and three IT constructs (adoption, standardization, and innovation) for clinical and supply chain IT. Multivariate fractional logit, probit, and negative binomial regressions are applied. Findings: Multivariate regressions controlling for IDS and market characteristics find that measures of IT adoption, IT standardization, and innovative IT adoption are significantly associated with centralization of IT decision rights and strategic alignment. Specifically, centralization of IT decision rights is associated with 22% higher adoption of Bar Coding for Materials Management and 30%–35% fewer IT vendors for Clinical Data Repositories and Materials Management Information Systems. A combination of centralization and clinical IT strategic alignment is associated with 50% higher Computerized Physician Order Entry adoption, and centralization along with supply chain IT strategic alignment is significantly negatively correlated with Radio Frequency Identification adoption Practice Implications: Although IT adoption and standardization are likely to benefit from corporate governance practices within IDSs, innovation is likely to be delayed. In addition, corporate governance is not one-size-fits-all, and contingencies are important considerations.

Why primary care practices should become digital health information hubs for their patients

BackgroundTwo interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible.DiscussionWe contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive.SummaryWe view the primary care practice as a central component of digital information coordination, especially when considering the current challenges of digital health information fragmentation. Given these fragmentation issues and the emphasis on primary care as central to improving health and lower overall health care costs, we suggest that primary care practices should embrace their evolving role and should seek to become digital health information hubs for their patients.

When traditionally inseparable services are separated by technology: the case of patient portal features offered by primary care providers

Health-care services have traditionally been provided and consumed simultaneously, as exemplified by in-person patient visits to primary care providers (PCPs), where clinical assessment and treatment are provided and consumed face-to-face. Technological intermediation is changing this traditional assumption, however, as patient-centric technologies, such as patient portals, are creating service separation opportunities. While service separation facilitated by patient portals may bring welcome changes to access, efficiency, and clinical outcomes, usage of patient portals by health-care consumers remains low. Suboptimal demand-side usage of patient portals, especially at the primary care level, could have significant negative implications for patient-centered policy initiatives predicated on patient empowerment and engagement. This paper contributes to this important policy context by reporting findings from a study designed to assess patient perceptions associated with hypothetical patient portal features offered by PCPs and potential subsequent impacts to PCP loyalty and switching propensity. We find that patient portal features focused on back-office (clinical) self-service capabilities (such viewing health records or summaries from prior visits) are perceived positively by consumers, but, interestingly, clinical digital communication and collaboration features (such as online video consultations with physicians) do not have significant perception impacts. These findings suggest that patient portals may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.

An economic framework for transitioning to capacity building

Global Health Organizations (GHOs) often focus on resource provisioning strategies to assist communities in need, especially when disaster strikes. While such strategies are commendable, how should GHOs approach the challenge of developing sustainable strategic objectives after critical needs have been addressed? Leveraging the context of GHOs partnering with communities in need of support after disaster strikes, we propose an economic framework for use in strategic assessment and transition planning. We focus on a strategic process by which GHOs can systematically assess and manage the temporal shift from resource provisioning to capacity building strategies. The proposed framework is applied to pragmatic field experiences undertaken by the American Red Cross in the aftermath of the 2007 Peru earthquake. We specifically develop and propose: (1) An economic strategy assessment framework for GHOs seeking to provide support to communities characterised by high risk variances, incentive complexities and contingencies, and, (2) A practical strategic transition model for GHOs that emphasises proactively moving towards capacity building programme objectives through an emphasis on co-creation of value with community partners.

The Evolving Intellectual Structure of the Health Informatics Discipline: A Multi-Method Investigation of a Rapidly-Growing Scientific Field

Scientific disciplines are self-defined and self-evolving to a large extent, but acknowledging that disciplines develop organically does not diminish the continuing need to more fully understand the underlying dynamics of their intellectual structures. Intellectual structures bespeak the topics (including paradigms) that a discipline selects, the sub-disciplines and sub-communities that emerge, the thought leaders who direct the efforts of its various research programs, and the relationships between these various structural components. One such discipline, the discipline of health informatics (HI), is not only a vitally important discipline for societies worldwide, but is also an enormous field that manifests itself in the natural and social sciences as well as in the management sciences and applied disciplines including professionals such as physicians, nurses, paramedics, and so forth.A subset of the HI field especially important to management scholars is identified here as health information technology (HIT). The current study analyzes the intellectual underpinnings of the field of HI and, in particular, focuses on its sub-discipline HIT. Using the multiple statistical methods including citation and co-citation analysis, social network analysis (SNA), and latent semantic analysis (LSA), we show how HIT research has emerged in management journals and distinguished itself from the larger HI context. The research themes, intellectual leadership, cohesion of these themes and networks of researchers, and journal presence revealed in our longitudinal intellectual structure analyses foretells how, in particular, these HI and HIT fields have evolved to date and also how they could evolve in the future. Our findings identify which research streams are central (versus peripheral) and which are cohesive (as opposed to disparate). Suggestions for vibrant areas of future research emerge from our analyses.

Reflective Technology Assimilation: Facilitating Electronic Health Record Assimilation in Small Physician Practices

Abstract Effectively incorporating complex technology into organizational practices requires moving beyond initial plateaus of postadoption usage. However, achieving this is especially challenging for small businesses because competing priorities in addition to resource and attention constraints may lead to technology assimilation satisficing. With this context in mind, we conducted a four-year action research project in which we supported electronic health record (EHR) assimilation in 10 small physician practices by facilitating reflections to help these small organizations move beyond an initial plateau of postadoption EHR usage. Drawing from these results, we theorize reflective technology assimilation (RTA) as an emergent process of facilitating deeper learning and reflection within and across small resource- and attention-constrained organizations to enable ongoing technology assimilation. In addition, we articulate the foundational principles for reflective action research (RAR) as an approach in which researchers facilitate reflective problem solving while advancing theoretical knowledge.

Product Line Extension in Consumer Software Markets in the Presence of Free Alternatives

Hypercompetitive consumer software markets pit incumbents against free alternatives and pirates. Although the extant literature has studied firm level strategic responses to consumer heterogeneity and piracy, there is a lack of understanding of consumer reactions to digital goods choice sets that include firm product extensions such as the introduction of premium or free alternatives. With context-dependent preferences as the theoretical basis, this study systematically examines the impact of piracy controls and product line extensions on welfare in a consumer software market context (i.e., willingness to pay (WTP) and changes in consumer and producer surplus). In two controlled experiments using double-bound-dichotomous-choice WTP elicitation, we investigate how piracy controls and product line extensions impact two different platforms of the same software (PC Adobe applications and mobile Adobe applications) in terms of propensity to pirate and WTP. We show that introducing a premium or free vertical extension has different impacts on consumers’ WTP for the focal product depending on whether it is a low-cost or high-cost market even when controlling for individual differences, such as price fairness perceptions, product feature value, brand perceptions, etc. By contrast, piracy controls reduce piracy rates but have a limited impact on consumer WTP for the focal product in both contexts. By calculating the overall welfare of the market, we show that there is alignment in consumer and producer interests at current and estimated optimal price levels in both high-cost and low-cost markets. However, the introduction of a free product extension leads to a higher surplus in the high-cost market, whereas the introduction of the premium product extension leads to a higher surplus in the low-cost market.

Opening the envelope of health care information systems research

Abstract In 2004, Chiasson and Davidson published a challenge to the scholarly Information Systems (IS) field to embrace health information systems research more fully within its mainstream research interests. In the ensuing 14 years, health care research has become an acknowledged specialization within the IS field. In this review article, we examine how health care research publications have developed within the IS fields leading journals since 2004 and explore the analytical and technological areas of focus within these publications. In addition to providing a descriptive overview of such research, we also examine three topical clusters in-depth (health IT adoption and diffusion, physician resistance to health IT use, and health IT impact on health care or system outcomes) to consider how researchers have addressed the challenge of developing general IS knowledge within this distinctive research context while also contributing contextually-relevant insights to the health care field. Finally, we discuss the implications of these analyses and suggest potential areas for future research. Overall, we contribute a foundation for IS health care researchers to consider how to position their work to contribute to knowledge through informational and organizational theory as well as to address important concerns of practice at the intersection of health and IS.