Academic journal article Journal of the Association for Information Systems

Advocating for Action Design Research on IT Value Creation in Healthcare

Academic journal article Journal of the Association for Information Systems

Advocating for Action Design Research on IT Value Creation in Healthcare

Article excerpt


Today there is mixed evidence that health IT decreases costs and/or improves care quality in the US. Some of the same factors that have driven delays in realizing the benefits from IT investments in other industries (i.e., time consuming process changes) are apparent in the U.S. healthcare industry, which is only now digitizing its fundamental patient data, the electronic health record. The healthcare industry itself is in transition and new IT may not provide full benefit unless it is accompanied with a restructuring of healthcare delivery. Traditional ex post approaches to measuring IT value will limit the ability of healthcare IT value researchers to add value to practice now especially as government incentives in the US drive significant investment. But generalizing results from traditional IT value research to the healthcare setting is risky due to differences between healthcare and other industries. I advocate for action design research that uses existing theory as a foundation, but adapts it to the specific unique characteristics of this industry. By actively participating in the design and evaluation of new socio-technical systems, IT value researchers can generate grounded theory to explain value creation in healthcare while influencing practice now.

Keywords: Heath IT, Value of Health IT, Benefits From Health IT, IT Value, Action Design Research, Action Research, Design Science Research.

1. Introduction

While the US spends far more on healthcare than any other country, it does not provide superior care. In 2009, the US spent nearly $8,000 per person on healthcare services, while 12 other industrialized nations spent just one-third to two-thirds as much. Meanwhile, in comparison to other nations, the US had the highest rates of potentially preventable deaths from asthma and amputations due to diabetes, and rates that were no better than average for in-hospital deaths from heart attack and stroke (Squires, 2012).

To address this problem, the U.S. Government has created several initiatives to increase IT's role in healthcare. However, thus far, there is mixed evidence on the benefits from health IT for decreasing costs, improving quality of care, and/or improving patient safety (Agarwal, Gao, DesRoches, & Jha, 2010; Committee on Patient Safety and Health Information Technology, 2012; DesRoches et al., 2010; Himmelstein, Wright, & Woolhandler, 2009). While many U.S. healthcare institutions are now implementing generic commercial applications, most of the studies that found positive impacts involved academic and institutional leaders that custom-developed systems optimized for their settings (Agarwal et al., 2010; Chaudhry et al., 2006; Shekelle, Morton, & Keeler, 2006). And some studies have actually found negative impacts (Black et al., 2011 ; Garg et al., 2005; Himmelstein et al., 2009; Reckmann, Westbrook, Koh, Lo, & Day, 2009).

The mixed results of IT investments in healthcare are similar to those previously reported in other industries, such as finance and manufacturing, that digitized customer transactions and processing decades earlier. It took IT researchers years to unravel how, when, and why value is generated from IT investments. IT researchers now not only understand how to study IT value, but they also have a solid body of knowledge regarding the factors that generate it (Kohli & Grover, 2008), especially the time-consuming process changes required. IT value researchers are well positioned to use this knowledge to explain how IT might benefit the healthcare industry. However, since industry is an important differentiator in IT research (Chiasson & Davidson, 2005), it is likely that industry differences will affect how IT value is captured in the healthcare industry. Additionally, traditional IT value research approaches that deal with the outcome of past IT investments through post hoc analysis will be neither timely nor relevant to influence healthcare practice now, when substantial investment incentives are spurring adoption and industry change. …

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