William G. Chismar

Does the extended technology acceptance model apply to physicians

In previous studies, the technology acceptance model (TAM) (Davis, 1989) has been widely used by information technology researchers to gain a better understanding of information technology (IT) adoption and its use in organizations. While TAM has been applied and tested in academic and corporate settings, involving students, business managers, clerical and administrative types as subjects, few studies have evaluated TAM in the health care environment. This study examines the applicability of the extended technology acceptance model (TAM2) of Venkatesh and Davis (2000) in the context of physicians intention to adopt Internet-based health applications. Data were collected in a survey of pediatricians to see how well the extended model, fits in the medical sector. Our results partially confirm the model, however significant theoretical aspects were not supported. One of the core perception variables, perceived ease of use, did not predict intention to use in this study. As theorized, the primary predictor variable perceived usefulness was a strong determinant of intention to use. This paper discusses the implications, limitations, and possible explanations for the inconsistencies within the model when applied to such professional users as physicians.

A model of competing interorganizational systems and its application to airline reservation systems

Abstract Interorganizational systems (IOS) are automated information systems that cross company boundaries. This article presents a descriptive model of competition between providers of interorganizational systems in a mature market. The model emphasizes the competitive role of switching costs in conjunction with user benefit functions which increase with the number of users. Also introduced is a notion of competitive position which aids in describing competitive risks and opportunities in a market. The case of airline computerized reservation systems (CRS) is used throughout the paper to demonstrate the model.

Examining the organizational implications of IT use in hospital-based health care: a case study of computerized order entry

The paper reports on the preliminary findings of an in-depth case study of the implementation of a computerized order entry (COE) system at a medium sized, acute care hospital. We propose a theoretically grounded framework, based on work by S.R. Barley (1986; 1990), for analyzing organizational changes that may result from COE introduction and use the framework to analyze findings at the research site. The hospital studied was largely successful in implementing and utilizing the system. However, use of the COE has altered the content and structure of order related information that passes between key participants in clinical care, affecting how these occupational groups and departments communicate and interact by creating ambiguity and uncertainty about order information. Use of the system may also be enabling increased organizational control over clinical care practices, exercised through professional norms and the clinical administrative hierarchy. Findings were consistent with other studies of COE use, suggesting that future research could focus on the consequences of structuring the content of order related communications on interactions between clinical and ancillary departments and the need to integrate the COE with other clinical systems to minimize disruptions.

Health Cyberinfrastructure for Collaborative Use-Inspired Research and Practice

Rapid advances in information and networking technologies have greatly expanded the modes for conducting business and science. For the past two decades, the National Science Foundation (NSF) has been supporting efforts to develop a comprehensive cyberinfrastructure with the goal of transforming the nature of scientific investigations. More recently, the NIH began supporting efforts to develop a cyberinfrastructure of healthcare research and practice. However, the best structure and applications of cyberinfrastructure in health care have yet to be defined. To address these issues, the NIH and the Kay Center for E-Health Research at Claremont Graduate University sponsored a symposium on Cyberinfrastructure for Public Health and Health Services: Research and Funding Directions. The symposium convened researchers, practitioners, and federal funders to discuss how to further cyberinfrastructure systems and research in the public health and health services sectors. This paper synthesizes findings of the symposium, the goals of which were to determine the dynamics necessary for executing and utilizing cyberinfrastructure in public health and health services; examine the requirements of transdisciplinary collaboration; and identify future research directions. A multi-faceted conception of use-inspired research for cyberinfrastructure is developed. Use-inspired research aims to further basic theory but is grounded, inspired, and informed by practical problems. A cyberinfrastructure framework is presented that incorporates three intersecting dimensions: research-practice, health services-public health, and social-technical dimensions. Within this framework, this paper discusses the ways in which cyberinfrastructure provides opportunities to integrate across these dimensions to develop research and actions that can improve both clinical outcomes and public health.

Online self-disclosure : model for the use of internet-based technologies in collecting sensitive health information

Patient information is often incomplete or inaccurate, undermining patient care. Information technologies for interviewing may motivate individuals to report higher levels of stigmatised or illicit activities and lower levels of normative behaviour in comparison to traditional interviewing methods. The role of internet-based technologies for gathering more accurate information, however, remains unproven and is often contradictory because the motivating factors are infrequently addressed. We develop a self-disclosure model based on a synthesis of previous studies on self-disclosure of personal health information. Our review of the literature suggested that self-disclosure is affected by three motivating factors: patient perceptions of privacy, context sensitivity, and the information value of content and feedback. Internet-based technologies can influence these motivating factors and may improve the quality of patient information by increasing the self-disclosure of health-risk behaviours.

A self-disclosure model for personal health information

The use of information technologies (IT) to collect personal health information is growing in popularity via computer-assisted interviewing and a wide variety of healthcare Web sites. However, a review of the literature on computer-assisted interviewing exhibits confounding and equivocal results regarding the effects of IT on individuals willingness to disclose socially sensitive health information. Some studies revealed individuals heightened concerns about entering their health information into a computer, while other studies exhibited greater willingness to enter sensitive information into a computer than to give it to a personal physician. The pervading lack of clarity in explaining these results may be largely due to limited attempts to model the underlying factors that motivate the self-disclosure of socially sensitive personal health information; most studies examine the relationship between the data collection environment and the willingness to self disclose without identify the underlying factors. In this paper, we propose a model of self-disclosure that contains three classes of motivating factors derived from a decomposition of the data collection environment of previous studies: perceived privacy, context sensitivity, and quality of feedback. Aspects of the data collection environment that reinforce the motivational factors are expected to increase disclosure and thus improve the quality of information. An analysis of the results of previous studies employing IT-enabled data-collection environments offers preliminary support of the proposed model. After presenting the model, we discuss research implications and suggest approaches for validating the self-disclosure model.

What Airline Reservation Systems Tell Us about the Future of EHRs

In the airline industry, the justification for adoption of computerized reservation systems (CRSs), shifted from operational efficiency, to marketing strategies to recoup investment, to competitive advantages of essential business tools. This progress contributed to fundamental changes in the structure of the industry. In large part, network externalities created by these systems and the discrepancy between who paid for the systems, and who reaped the financial benefits drove these changes. In this paper we argue that 1) this turbulent systems evolution was driven by environmental, technological, and structural factors, 2) it is analogous to current trends in the health care industry and that 3) similar patterns of adoption will occur in electronic health records (EHRs). Lessons learned from the evolution of CRSs are utilized to analyze problems and issues in the development of EHRs. We conclude with recommendations for the evolution of EHRs as essential tools in the health care industry.

US provision of telecommunications goods and services in the PRC: Chinese policies and American strategies

Telecommunications is one of the fastest growing sectors of the Chinese economy today. In the face of this growth, the governments traditional approach of strong centralized planning and control is proving ineffective and showing signs of changing. Foreign firms interested in entering Chinas telecommunication market must adjust their strategies accordingly. This paper presents recent research on foreign investment in Chinas telecommunications sector with particular attention given to the entry by US firms into that market. The findings are based on interviews with government officials, Chinese representatives of US firms, US business people and embassy officers.

China's movement toward a national information infrastructure

Since implementing economic reforms in 1979, Chinas economy, spurred by foreign investment, has been growing at an average annual rate of ten percent. Unfortunately for companies doing business in China, reliable connections to telecommunications and computer networks have only recently become available in the major cities and are non-existent in most of the country. In response, the Chinese government has made the development of an information infrastructure a high priority, but its efforts have been hindered by conflicting political and business interests. In this paper we look at two aspects of the development of an information infrastructure in China: telecommunications development and the internet. Currently the central government maintains tight control over telecommunications development, but this control is quickly breaking down. The internet in China has been developing in a totally separate environment, largely out of the control of the central government; but recent policy changes have brought strict controls over the Internet. This paper presents at Chinas progress toward a national information infrastructure in light of the political and economic conflict.

Introduction to minitrack: information technology in health care settings in countries with developing economies (CDEs)

Healthcare delivery systems around the world are facing a crisis precipitated by ever-escalating costs due to the epidemiologic transition, increasing costs of pharmaceuticals and medical technology, and an aging demographic. Perhaps the world’s best opportunity to meet these challenges can be found by adopting and implementing health management information systems (HMIS) to increase accessibility, improve productivity and, finally, last but not least, to provide better quality health care. Until recently the “developing world” could not afford to implement complex information technology in its health sector due to the high costs of computerization and the generally low capacity which was found in many/most CDEs. Both of these factors are rapidly changing. Information technology, with few exceptions, continues to enjoy an ever-decreasing price point and a deflationary cycle. Increases in some software costs are offset by huge decreases in hardware costs. This makes HMIS projects more affordable with each passing day. Likewise the educational institutions in many CDEs continue to stress computer science and related disciplines, graduating some of the world’s best experts in the field. India, for example, has become a powerhouse, and many other countries are rapidly following its example Finally, those organizations which provide funding for infrastructure projects, such as the World Bank, the Asian Development Bank, USAid and others, are increasingly funding such projects throughout, at the request of their clients. This year is the second year that HICSS has hosted this mini-track. Three papers are presented this year. The firsts looks at adoption of IT in healthcare settings in China. The authors apply Structuration Theory to conceptualize the concept of information culture, which is then used to analyze relationships between information culture and the development of e-health in China. The second paper presents analysis of and recommendations from information systems used for drug prevention, control, and treatment in Chile. Evaluations of the systems are discusses, as well as recommendations for IT support of cooperative, international efforts to combat the drug problem. The final paper presents an evaluation of a virtual microscopy system and discusses potential applications of the technology in countries with developing economies. Regardless of your host environment, whether you are from Hawai‘i, the USA mainland, the developed Asian countries or elsewhere, we can all learn from their experiences.