Toward an Effective Strategy for the Diffusion and Use of Clinical Information Systems
- Correspondence and reprints: Stephen M. Davidson, Ph.D., Boston University School of Management, 595 Commonwealth Avenue, Boston, MA 02215; email: <sdavidso{at}bu.edu>
- Received 24 August 2006
- Accepted 26 January 2007
Abstract
The full impact of IT in health care has not been realized because of the failure to recognize that (1) the path from availability of applications to the anticipated benefits passes through a series of steps; and (2) progress can be stopped at any one of those steps. As a result, strategies for diffusion, adoption, and use have been incomplete and have produced disappointing results. In this paper, we present a comprehensive framework for identifying factors that affect the spread, use, and effects of IT in the U.S. health care sector. The framework can be used by researchers to focus their efforts on unanswered questions, by practitioners considering IT adoption, and by policymakers searching for ways to spread IT throughout the system.
Footnotes
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Earlier versions of this paper were presented at a conference, Exploring Innovation Processes in Healthcare: The Challenges of Collaboration and Governance. Bentley College, Waltham, MA. May 18, 2006; and at The Third International Conference on Technology, Knowledge and Society. New Hall, Cambridge University, England. January 12, 2007.
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↵† Jonathan Bush, the president of athenahealth, an IT firm whose clients fax paper records to be input by the firm’s staff, indicated that his company’s interest in EMRs stems, in part, from the fact that a large proportion of orders for tests, prescriptions, and other services are not filled. Its EMR tracks those orders, and its staff informs the physician or practice of ones which were not followed, thus, giving the practice a chance to follow up, discover the reasons, and complete the service. In this case, improved quality may be one result if it helps the patient complete a prescribed course of treatment. On the other hand, it is worth noting that a key motivation for the IT firm derives from its “business model.” Since its own compensation is a percentage of practice revenues, failure of a patient to complete some services results in reductions of the firm’s income, and using the EMR as part of an effort to complete the services results in increased income for both the practice and the IT company. Ironically, therefore, to the extent that use of the EMR results in more revenues to the practice, health care expenditures may actually increase, thus, negating one of the purposes that BTE, DOQ-IT and other groups hope to achieve with the broad diffusion of EMRs.
