Marie-Claude Trudel

Synthesizing information systems knowledge: A typology of literature reviews

Abstract In this article we develop a typology of review types and provide a descriptive insight into the most common reviews found in top IS journals. Our assessment reveals that the number of IS reviews has increased over the years. The majority of the 139 reviews are theoretical in nature, followed by narrative reviews, meta-analyses, descriptive reviews, hybrid reviews, critical reviews, and scoping reviews. Considering the calls for IS research to develop a cumulative tradition, we hope more review articles will be published in the future and encourage researchers who start a review to use our typology to position their contribution.

Knowledge barriers to PACS adoption and implementation in hospitals.

PURPOSE Drawing on the classical theory of diffusion of innovations advanced by Rogers [E.M. Rogers, Diffusion of Innovations, 4th ed., Free Press, New York, NY, 1995] and on the theory of barriers to innovation [P. Attewell, Technology diffusion and organizational learning: the case of business computing. Organ. Sci. 3 (1992) 1-19; H. Tanriverdi, C.S. Iacono, Knowledge barriers to diffusion of telemedicine. Proceedings of the 20th International Conference on Information Systems, Charlotte, NC, 1999, pp. 39-50; S. Nambisan, Y.-M. Wang, Roadblocks to web technology adoption? Commun. ACM, 42 (1) (1999) 98-101], this study seeks a better understanding of challenges faced in PACS implementations in hospitals and of the strategies required to ensure their success. METHODS To attain this objective, we describe and analyze the process used to adopt and implement PACS at two Canadian hospitals. RESULTS Our findings clearly demonstrate the importance of treating any PACS deployment not simply as a rollout of new technology but as a project that will transform the organization. Proponents of these projects must not lose sight of the fact that, even if technological complexity represents a significant issue, it must not garner all the project teams attention. This situation is even more dangerous, inasmuch as the greatest risk to the implementation often lies elsewhere. It would also appear to be crucial to anticipate and address organizational and behavioral challenges from the very first phase of the innovation process, in order to ensure that all participants will be committed to the project. CONCLUSIONS In order to maximize the likelihood of PACS success, it appears crucial to adopt a proactive implementation strategy, one that takes into consideration all the technical, economic, organizational, and human factors, and does so from the first phase of the innovation process.

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.

Health information technology success and the art of being mindful: preliminary insights from a comparative case study analysis.

Background: Information technologies (ITs) represent an important lever for improving performance in health care systems. In recent years, most industrialized countries have made substantial investments in this area. Nevertheless, the sad truth is that far too many of these IT projects have failed. Purpose: The primary goals of this study were to explore the notion of mindfulness proposed by E. B. Swanson and N. C. Ramiller (2004) and to assess the extent to which, and how, innovating mindfully influences health IT project success. Methodology: Two in-depth case studies were conducted in comparable health care organizations that adopted the same clinical information system. Observation, semistructured interviews, informal discussions, and documentation were the primary data collection methods. Data analyses were performed following recognized guidelines. Results: Throughout the unfolding of the two projects, the actions and decisions of key stakeholders reflected different levels of mindfulness. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes. Practice Implications: Taking action and making decisions in light of the particular context of each particular health IT project, that is, innovating mindfully, favor innovation acceptance and positive outcomes, whereas acting and deciding following fads, fashion, or best practices without paying attention to the specifics of the project context, that is, innovating mindlessly, increase the risk of human resistance and limited added value.

The effects of a regional telepathology project: a study protocol

BackgroundTelepathology, which is an emerging form of telemedicine in Canada, is defined as the electronic transmission of pathological images, usually derived from microscopes, from one location to another. There are various applications of telepathology, including case referral for an expert opinion, provision of an emergency service in the absence of a resident pathologist, and education. Until now, there has been relatively little use of telepathology for core diagnostic services in the absence of a local pathologist, but this practice is likely to increase in the future. The Laval University Integrated Health Network is in the process of deploying a telepathology system, primarily to provide an intraoperative frozen section service to small hospitals in sparsely populated areas which are experiencing a severe shortage of on-site pathologists. The telepathology project involves 17 hospitals located in five regions of eastern Quebec, Canada. This paper describes the study protocol that will be used to evaluate the benefits associated with the project.Methods/DesignA panel of experts was first assembled by Canada Health Infoway to agree on a set of benefits indicators that could be applied to all telepathology projects across Canada. Using the set of indicators as an input, we have developed a three-step study protocol. First, a survey questionnaire will be distributed to appraise the way pathologists, pathology technologists and surgeons perceive the telepathology system and its impacts. Second, a series of semi-structured interviews will be conducted with project leaders and telepathology users at sites that are representative of all the hospitals in the Laval University Integrated Health Network. The overall aim is to better understand the expected and unexpected effects of telepathology on health care professionals and patients as well as on the regional organization and delivery of care services. Finally, a pre-post design using secondary data is proposed to evaluate a wide array of tangible benefits to the patients, the health care providers, the hospitals, and the region as a whole.DiscussionThe Laval University Integrated Health Networks telepathology project is expected to yield positive and significant results that are relevant internationally. Our findings will provide valuable information on the nature and extent of benefits associated with telepathology systems intended to provide an intraoperative frozen section service to remote hospitals experiencing a shortage of specialists.

The Live Teaching Case: A New IS Method and its Application

When teaching Information Systems (IS), one of the crucial objectives is to make students understand the practical aspects of the integration of IS in organizations. Over the last decades, several pedagogical approaches were introduced to more tightly bridge theory and practice, e.g., hands on exercises, simulations, real world projects, guest speakers, and case studies. In this paper, we introduce a pedagogical approach novel to IS which brings practice into the classroom, i.e., the live teaching case method. The live teaching case method is a hybrid between a guest speaker event and a teaching case. The live teaching case method is different from a written case as it is the animator who experienced the case who is verbally presenting the case. The live teaching case is different from a guest speaker event as it is more focused around specific decision points, such as a written case would be. We believe that the live teaching case approach alleviates several of the traditional case method shortcomings while maximizing the benefits associated with the presence of a guest speaker in class. This paper outlines the various steps involved in the live teaching case including initiating contact, planning the decision points, selecting student readings and developing pre-course materials, guiding the initial presentation and discussion, guiding the presentation and discussion of the managerial decision points, and class wrap-up. This approach is explained and then illustrated using three different IS courses, namely, an IS project management course, a systems analysis and design course, and a capstone course on enterprise system implementation.

Adoption, Use, and Impact of E-Booking in Private Medical Practices: Mixed-Methods Evaluation of a Two-Year Showcase Project in Canada

Background Managing appointments in private medical practices and ambulatory care settings is a complex process. Various strategies to reduce missed appointments can be implemented. E-booking systems, which allow patients to schedule and manage medical appointments online, represents such a strategy. To better support clinicians seeking to offer an e-booking service to their patients, health authorities in Canada recently invested in a showcase project involving six private medical clinics. Objective The objectives pursued in this study were threefold: (1) to measure adoption and use of the e-booking system in each of the clinics over a 2-year period, (2) to assess patients’ perceptions regarding the characteristics and benefits of using the system, and (3) to measure the impact of the e-booking system on the number of missed appointments in each clinic. Methods A mixed-methods approach was adopted in this study. We first extracted and analyzed raw data from the e-booking system deployed in each of the medical practices to monitor adoption and use of the system over time and to assess the impact of the system on the number of missed appointments. Second, we conducted a Web-based survey of patients’ perceptions in the spring of 2013. Results The patients and physicians targeted by this showcase project showed a growing interest in the e-booking system as the number of users, time slots made available by physicians, and online appointments grew steadily over time. The great majority of patients said that they appreciated the system mainly because of the benefits they derived from it, namely, scheduling flexibility, time savings, and automated reminders that prevented forgotten appointments. Importantly, our findings suggest that the system’s automated reminders help significantly reduce the number of missed appointments. Conclusions E-booking systems seem to represent a win-win solution for patients and physicians in private medical practices. We encourage researchers to replicate and extend our work in other primary care settings in order to test the generalizability of our findings.

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.

Too Much or Not Enough: Information Systems Integration in Post-merger Context -- A Sociomaterial Practice Perspective

During the post-merger integration phase (PMI), new information systems (IS) that span the boundaries of the previously independent organizations need to be implemented to enable a specific level of integration. Although the literature emphasizes the important role played by ISs in support of the amalgamated organizations, there is a lack of studies on the issue of boundary management at the information technology (IT) level in a PMI context. We draw on a sociomaterial practice perspective to analyze two IS implementation projects in a healthcare organization resulting from a merger of previously independent hospitals. The results suggest there is a dilemma of post-merger IT integration versus autonomy, which is reflected by the unpredictability of the implementations outcomes for the ISs designed to enable planned practices. The model also suggests that post-merger practices reflect the outcomes of dialectic processes of resistance to, and negotiation of, the IS configuration during its implementation.

Unpredictable Reconfigurations: The Dilemma of the Post-Merger Information Systems Integration1

A merger is the result of a strategic decision aimed at creating synergy. Notwithstanding mergers’ expected benefits, their outcomes are often beset by problems such as employees’ high levels of stress, dissatisfaction and resistance. Research suggests that these problems are often related to the issue of boundary management during the post-merger integration phase (PMI), which refers to the degree of integration required among the merging parties and the degree of autonomy, that each must retain for the merger to achieve synergy. The literature identifies information systems (IS) as being a key enabler of successful mergers and suggests that during PMI, new ISs that span the boundaries of the previously independent firms need to be implemented to facilitate a specific level of integration. Yet, there is a paucity of studies on the issue of boundary management at the information technology (IT) level during PMI. Adopting a sociomaterial perspective and based on a qualitative study within a healthcare organization, the authors find that post-merger practices were the result of dialectic processes of resistance to, and negotiation of, the IS reconfiguration after its implementation.