Corey M. Angst

Adoption of electronic health records in the presence of privacy concerns: the elaboration likelihood model and individual persuasion

Within the emerging context of the digitization of health care, electronic health records (EHRs) constitute a significant technological advance in the way medical information is stored, communicated, and processed by the multiple parties involved in health care delivery. However, in spite of the anticipated value potential of this technology, there is widespread concern that consumer privacy issues may impede its diffusion. In this study, we pose the question: Can individuals be persuaded to change their attitudes and opt-in behavioral intentions toward EHRs, and allow their medical information to be digitized even in the presence of significant privacy concerns? To investigate this question, we integrate an individuals concern for information privacy (CFIP) with the elaboration likelihood model (ELM) to examine attitude change and likelihood of opting-in to an EHR system. We theorize that issue involvement and argument framing interact to influence attitude change, and that concern for information privacy further moderates the effects of these variables. We also propose that likelihood of adoption is driven by concern for information privacy and attitude. We test our predictions using an experiment with 366 subjects where we manipulate the framing of the arguments supporting EHRs. We find that an individuals CFIP interacts with argument framing and issue involvement to affect attitudes toward the use of EHRs. In addition, results suggest that attitude toward EHR use and CFIP directly influence opt-in behavioral intentions. An important finding for both theory and practice is that even when people have high concerns for privacy, their attitudes can be positively altered with appropriate message framing. These results as well as other theoretical and practical implications are discussed.

Differences Between Integrated And Stand-Alone E-Prescribing Systems Have Implications For Future Use

Understanding the benefits of electronic prescribing systems has important implications for quality and efficiency in medical care. We surveyed physicians about their use of e-prescribing in outpatient practices. We found that physicians who use e-prescribing systems integrated into an electronic health record have different characteristics, usage patterns, perceived benefits, and levels of satisfaction than physicians who use stand-alone systems. For example, although only 56 percent of the physicians we surveyed said that they checked a patients drug history most or all of the time when writing a prescription, those with integrated systems were significantly more likely to report doing so than their counterparts with stand-alone systems. Our findings have implications for the American Recovery and Reinvestment Acts requirements for e-prescribing and the future use of this technology. Because many stand-alone systems cannot meet meaningful-use requirements, there is likely to be a shift toward integrated systems.

Technological viewpoints (frames) about electronic prescribing in physician practices

OBJECTIVE Physician practices may adopt and use electronic prescribing (eRx) in response to mandates, incentives, and perceived value of the technology. Yet, for the most part, diffusion has been limited and geographically confined, and even when adopted, use of eRx in many practices has been low. One explanation for this phenomenon is that decision-makers in the practices possess different technological viewpoints (frames) related to eRx and these frames have formed the basis for the adoption decision, expectations about the technology, and patterns of use. In this study eRx technological frames were examined. DESIGN Focus groups, direct observation, and semi-structured interviews were conducted with physicians, practice managers, nurses, and other medical staff. MEASUREMENTS Focus groups were observed, taped, transcribed, and analyzed to reveal themes. These themes guided the observational visits and subsequent interviews. A triangulation process was used to confirm the findings. RESULTS Seven frames emerged from the qualitative analysis ranging from positive to neutral to negative: (1) eRx as an efficiency and effectiveness enhancing tool; (2) eRx as the harbinger of new practices; (3) eRx as core to the clinical workflow; (4) eRx as an administrative tool; (5) eRx: the artifact; (6) eRx as a necessary evil; and (7) eRx as an unwelcome disruption. CONCLUSION Frames provide a unique perspective within which to explore the adoption and use of eRx and may explain why perceptions of value vary greatly. Some frames facilitate effective use of eRx while others impose barriers. Electronic prescribing can be viewed as a transitional technology on the path to greater digitization at the physician practice level. Understanding the impact of technological frames on the effectiveness of eRx use may provide lessons for the implementation of future health information technology innovations.

Information technology and voluntary quality disclosure by hospitals

Information asymmetry between consumers and health care providers is a well-known phenomenon in health care systems. Disclosure of health care quality information is one important mechanism through which hospitals can signal performance to potential patients and competitors, yet little is known about the organizational factors that contribute to voluntary disclosure. In this study we develop an empirical model to investigate the factors associated with choosing to participate in a voluntary quality disclosure initiative, specifically isolating the importance of information technology (IT) in facilitating disclosure. We extend the scope of prior work on the quality disclosure choice by augmenting it with an important decision variable: the operational costs of collecting and reporting quality data. We suggest that IT can facilitate disclosure by reducing these costs, thereby extending the literature on the value of IT. Empirical findings using data from a major voluntary quality disclosure program in California hospitals support our assertion related to the role of IT. Our results further highlight other hospital characteristics contributing to disclosure. We discuss implications of these findings for research and practice.

When Do IT Security Investments Matter? Accounting for the Influence of Institutional Factors in the Context of Healthcare Data Breaches

In this study, we argue that institutional factors determine the extent to which hospitals are symbolic or substantive adopters of information technology (IT) specific organizational practices. We then propose that symbolic and substantive adoption will moderate the effect that IT security investments have on reducing the incidence of data security breaches over time. Using data from three different sources, we create a matched panel of over 5,000 U.S. hospitals and 938 breaches over the 2005-2013 time frame. Using a growth mixture model approach to model the heterogeneity in likelihood of breach, we use a two class solution in which hospitals that (1) belong to smaller health systems, (2) are older, (3) smaller in size, (4) for-profit, (5) non-academic, (6) faith-based, and (7) less entrepreneurial with IT are classified as symbolic adopters. We find that symbolic adoption diminishes the effectiveness of IT security investments, resulting in an increased likelihood of breach. Contrary to our theorizing, the use of more IT security is not directly responsible for reducing breaches, but instead, institutional factors create the conditions under which IT security investments can be more effective. Implications of these findings are significant for policy and practice, the most important of which may be the discovery that firms need to consider how adoption is influenced by institutional factors and how this should be balanced with technological solutions. In particular, our results support the notion that deeper integration of security into IT-related processes and routines leads to fewer breaches, with the caveat that it takes time for these benefits to be realized.

Reducing Medicare Spending Through Electronic Health Information Exchange: The Role of Incentives and Exchange Maturity

Health information exchanges HIEs are entities that have emerged in healthcare delivery markets across the United States. By providing an interorganizational information system IOIS and governance over use of this system and the information exchanged through it, HIEs enable more routine and efficient electronic sharing of patient information between disparate and fragmented healthcare providers. This should result in improved quality and efficiency of care. However, significant questions persist about the extent to which HIEs produce these benefits in practice, particularly in terms of reducing healthcare spending. We use transaction cost economics TCE to theorize that HIEs establish a quasi-hierarchy that decreases frictions associated with information sharing in ways that reduce healthcare spending, and that the magnitude of reductions is greater when 1 insurer and provider incentives align, and 2 HIE capabilities mature. We can test these conjectures because HIEs, unlike other efforts that provide IOIS, are typically confined to regional markets and develop heterogeneously between these markets, introducing variation in insurer-provider incentive alignment and HIE maturity. Leveraging a unique national panel data set, we evaluate whether HIEs reduce spending for the largest insurer in the United States, i.e., Medicare, and whether incentives and HIE maturity modify the magnitude of reductions. We find significant spending reductions in healthcare markets that have established operational HIEs, with an average reduction of

How Does the Implementation of Enterprise Information Systems Affect a Professional’s Mobility? An Empirical Study

139 per Medicare beneficiary per year 1.4% decrease or a

Just what the doctor ordered? Physician mobility after the adoption of electronic health records

3.12 billion annual reduction in spending if HIEs were nationally implemented in 2015. We also find that these reductions occur disproportionately in healthcare markets where providers have financial incentives to use an HIE to reduce spending and when HIEs are more mature. Our results inform an important open empirical question in the healthcare domain related to the value of HIEs, while also joining perspectives from TCE with the IOIS literature to understand the factors that may be relevant to IOIS value creation more generally.

Reducing Medicare Spending Through Electronic Information Exchange: The Role of Incentives and Exchange Maturity

Although significant research has examined the effect of enterprise information systems on the behavior and careers of employees, the majority of this work has been devoted to the study of blue and grey collar workers, with little attention paid to the transformative effect IT may have on high status professionals. In this paper, we begin to bridge this gap by examining how highly skilled professionals react to the increasing presence of enterprise systems within their organizations. Specifically, we investigate how the implementation of enterprise systems— in the form of electronic health records (EHR)—affects the decision of physicians to continue practicing at their current hospital. Results suggest that when enterprise systems create complementarities for professionals, their duration of practice at the organization increases significantly. However, when technologies are disruptive and force professionals to alter their routines, there is a pronounced exodus from the organization. Interestingly, these effects are strongly moderated by individual and organizational characteristics, such as the degree of firm specific human capital, local competition, and the prevalence of past disruptions, but are not associated with accelerated retirement or the strategic poaching of talent by competing organizations.

A Tutorial on Empirical ICT4D Research in Developing Countries: Processes, Challenges, and Lessons

Although significant research has examined the effect of enterprise information systems on the behavior and careers of employees, the majority of this work has been devoted to the study of blue and grey collar workers, with little attention paid to the transformative effect IT may have on high status professionals. In this paper, we begin to bridge this gap by examining how highly skilled professionals react to the increasing presence of technology within their organizations. Specifically, we investigate how the implementation of electronic health record systems (EHRs) affects physician mobility and the decision to continue practicing at their current hospital. Results from a census of physicians in the state of Florida suggest that when these enterprise systems create complementarities for the physician, their tenure at the focal organization increases significantly. However, when technologies are disruptive to the physician’s routines, there is a pronounced exodus from the organization. Interestingly, d...