Josianne Marsan

Re-examining the causal structure of information technology impact research

About 20 years ago, Markus and Robey noted that most research on IT impacts had been guided by deterministic perspectives and had neglected to use an emergent perspective, which could account for contradictory findings. They further observed that most research in this area had been carried out using variance theories at the expense of process theories. Finally, they suggested that more emphasis on multilevel theory building would likely improve empirical reliability. In this paper, we reiterate the observations and suggestions made by Markus and Robey on the causal structure of IT impact theories and carry out an analysis of empirical research published in four major IS journals, Management Information Systems Quarterly (MISQ), Information Systems Research (ISR), the European Journal of Information Systems (EJIS), and Information and Organization (I&O), to assess compliance with those recommendations. Our final sample consisted of 161 theory-driven articles, accounting for approximately 21% of all the empirical articles published in these journals. Our results first reveal that 91% of the studies in MISQ, ISR, and EJIS focused on deterministic theories, while 63% of those in I&O adopted an emergent perspective. Furthermore, 91% of the articles in MISQ, ISR, and EJIS adopted a variance model; this compares with 71% from I&O that applied a process model. Lastly, mixed levels of analysis were found in 14% of all the surveyed articles. Implications of these findings for future research are discussed.

Improving performance in medical practices through the extended use of electronic medical record systems: a survey of Canadian family physicians

BackgroundNumerous calls have been made for greater assimilation of information technology in healthcare organizations in general, and in primary care settings in particular. Considering the levels of IT investment and adoption in primary care medical practices, a deeper understanding is needed of the factors leading to greater performance outcomes from EMR systems in primary care. To address this issue, we developed and tested a research model centered on the concept of Extended EMR Use.MethodsAn online survey was conducted of 331 family physicians in Canadian private medical practices to empirically test seven research hypotheses using a component-based structural equation modeling approach.ResultsFive hypotheses were partially or fully supported by our data. Family physicians in our sample used 67% of the clinical and 41% of the communicational functionalities available in their EMR systems, compared to 90% of the administrative features. As expected, extended use was associated with significant improvements in perceived performance benefits. Interestingly, the benefits derived from system use were mainly tied to the clinical support provided by an EMR system. The extent to which physicians were using their EMR systems was influenced by two system design characteristics: functional coverage and ease of use. The more functionalities that are available in an EMR system and the easier they are to use, the greater the potential for exploration, assimilation and appropriation by family physicians.ConclusionsOur study has contributed to the extant literature by proposing a new concept: Extended EMR Use. In terms of its practical implications, our study reveals that family physicians must use as many of the capabilities supported by their EMR system as possible, especially those which support clinical tasks, if they are to maximize its performance benefits. To ensure extended use of their software, vendors must develop EMR systems that satisfy two important design characteristics: functional coverage and system ease of use.

Has open source software been institutionalized in organizations or not

Context: Almost a decade ago, researchers in information systems and analysts of the information technology (IT) industry were predicting a bright future for open source software (OSS). Recent examples appear to lend support to this, but there exist many detractors of OSS and resistance to the transformation it creates. Thus, it is relevant to take a closer look at the institutionalization of OSS. Objective: This paper evaluates the extent of OSS institutionalization in organizations. A practice or innovation is said to be institutionalized when it is taken-for-granted and its use becomes the norm. Method: Drawing on institutional theory, the underlying concept of organizing vision and the rhetorical theory of diffusion of innovations, we analyze OSS institutionalization through the observation of the evolution of the public discourse about OSS and, simultaneously, the observation of the rate of adoption or diffusion of OSS in organizations. Results: OSS has become institutionalized for many back-end applications and is gradually becoming institutionalized for some front-end applications, mainly in small and medium enterprises but also in organizations in the financial, publishing, education, government and public sectors. Using the rhetorical theory of diffusion of innovations in tandem with the concept of organizing vision, we provide a deep understanding of the institutionalization of OSS by showing that it has not only diffused among organizations, but is also taken-for-granted in thought and social action. The positive tone and prominence of the public discourse on OSS have an important role to play in its institutionalization. Conclusion: The institutionalization of OSS in organizations cannot be underestimated by IT and business executives as well as key players in the IT industry. Future research efforts should be pursued and directed toward the institutionalization of particular OSS applications in a variety of industries and geographic regions.

Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices

BackgroundThere has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians’ progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a “tiered ceiling effect” and then we show why such phenomenon occurs.MethodsWe conducted in-depth case studies in three primary care medical practices in Canada where physicians had been using EMR systems for 3 years or more. A total of 37 semi-structured interviews were conducted with key informants: family physicians (about half of the interviews), nurses, secretaries, and administrative managers. Additional information was obtained through notes taken during observations of users interacting with their EMR systems and consultation of relevant documents at each site. We used abductive reasoning to infer explanations of the observed phenomenon by going back and forth between the case data and conceptual insights.ResultsOur analysis shows that a ceiling effect has taken place in the three clinics. We identified a set of conditions preventing the users from overcoming the ceiling. In adopting an EMR system, all three clinics essentially sought improved operational efficiency. This had an influence on the criteria used to assess the systems available on the market and eventually led to the adoption of a system that met the specified criteria without being optimal. Later, training sessions focussed on basic functionalities that minimally disturbed physicians’ habits while helping their medical practices become more efficient. Satisfied with the outcome of their system use, physicians were likely to ignore more advanced EMR system functionalities. This was because their knowledge about EMR systems came almost exclusively from a single source of information: their EMR system vendors. This knowledge took the form of interpretations of what the innovation was (know-what), with little consideration of the rationales for innovation adoption (know-why) or hands-on strategies for adopting, implementing and assimilating the innovation in the organization (know-how).ConclusionsThis paper provides a holistic view of the technological innovation process in primary care and contends that limited learning, satisficing behaviours and organizational inertia are important factors leading to the ceiling effect frequently experienced in the EMR system assimilation phase.

Improving performance in the ED through laboratory information exchange systems

BackgroundThe accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use.MethodsA survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted.ResultsThe great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care.ConclusionsExtensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.