دانلود رایگان مقاله کاربرد نظریه نهادی برای تصویب پرونده الکترونیکی سلامت

Abstract

This study uses institutional theory to explain adoption of electronic health records (EHRs) in ambulatory medical practices in the U.S. Health care is a highly institutionalized industry, subject to multiple regulatory forces, high levels of professionalism, and growing network externalities that can influence adoption decisions. We found that mimetic forces were more critical predictors when there was greater uncertainty, coercive forces were significant predictors after the U.S. government established incentives, and normative forces have continually influenced adoption. This study demonstrates the impact of the institutional effect of government policies and industry norms on adoption of critical technologies.

7. Conclusions and limitations

Our results suggest that institutional forces can have a major impact on technology adoption decisions in health care. Mimetic forces influence adoption primarily when there is uncertainty about the benefits. In the case of EHRs, we find that mimetic forces had almost as strong an effect as normative forces on EHR adoption in the absence of coercive forces. However, coercive forces provided by government regulation had a similar impact on adoption as normative forces. This study contributes to the literature on the role ofinstitutional theory in IT adoption. It also addresses the need to account for the contextual environment of health care in IS research. This is an industry that not only is highly institutionalized but also has traditionally had a strong professional logic that is currently being eroded via market mechanisms as well as government regulatory forces. We show that in such an industry institutional forces can have a strong influence on adoption decisions. In addition, this study contributes to practice by demonstrating the role of government policy on IS adoption. Prior to the HITECH regulations, adoption by other physicians within similar specialties had a slightly lower effect than that by physicians within the same hospital referral region, but neither resulted in high adoption by physicians. However, the coercive forces introduced with the HITECH Act rivaled normative forces and contributed to a doubling of adoption rates. While it is not surprising that federal regulations and incentives are an effective means of accelerating technological adoption, the fact that normative forces remain important after the implementation of such policies is a notable finding. It suggests that the benefits of EHR adoption are persistent in areas with the potential to link individual systems both within health-care networks and across networks through regional health information exchanges. By linking systems, more data will be available for analytics and ‘‘big data’’ analysis, with greater potential to reduce costs and improve quality. Finally, it is important to note that normative forces and the coercive forces exerted by the HITECH Act primarily benefit patients and third-party payers of medical services rather than physician decision makers.