IT-enabled Knowledge Management in Primary Care Settings: An Absorptive Capacity Perspective

Primary care medical practices have made sizable IT investments in recent years, primarily deploying electronic medical record (EMR) systems as well as Web-based elearning applications. The basic assumption here is that developing IT-enabled knowledge management capabilities may significantly improve the innovation and clinical performance of these organizations. Increasing uncertainty in their environment requires them to develop greater absorptive capacity (ACAP), i.e. an organizational learning capability to deal with the external sources of this uncertainty. In applying ACAP theory to primary care settings, this study seeks to answer the following research questions: What are the e-learning and EMR capabilities developed by primary care medical practices in response to increasing environmental uncertainty? To what extent does the development of an e-learning capability influence the development of an EMR capability? To what extent does building ACAP contribute to positive outcomes in terms of medical practices' innovation and clinical performance?

[1]  Robert A. Greenes,et al.  Evaluation of the Effect of Decision Support on the Efficiency of Primary Care Providers in the Outpatient Practice , 2015, Journal of primary care & community health.

[2]  Toni M. Somers,et al.  Impact of Environmental Uncertainty and Task Characteristics on User Satisfaction with Data , 2004, Inf. Syst. Res..

[3]  Guy Paré,et al.  Barriers to organizational adoption of EMR systems in family physician practices: A mixed-methods study in Canada , 2014, Int. J. Medical Informatics.

[4]  J. Grimshaw,et al.  Knowledge translation of research findings , 2012, Implementation Science.

[5]  Peter Vedsted,et al.  Juggling efficiency. An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings. , 2015, Social science & medicine.

[6]  Steven A. Melnyk,et al.  Operational Capabilities: The Secret Ingredient , 2010, Decis. Sci..

[7]  Bonnie Kaplan,et al.  Expanding multi-disciplinary approaches to healthcare information technologies: What does information systems offer medical informatics? , 2007, Int. J. Medical Informatics.

[8]  R. Glazier,et al.  Ontario's primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement. , 2013, Health affairs.

[9]  Michael Dinger,et al.  Absorptive Capacity and Information Systems Research: Review, Synthesis, and Directions for Future Research , 2012, MIS Q..

[10]  Nicholas Farmer,et al.  An update and further testing of a knowledge-based diagnostic clinical decision support system for musculoskeletal disorders of the shoulder for use in a primary care setting. , 2014, Journal of evaluation in clinical practice.

[11]  S de Lusignan,et al.  A knowledge-management model for clinical practice. , 2002, Journal of postgraduate medicine.

[12]  K. Carpenter,et al.  Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs. , 2014, Journal of substance abuse treatment.

[13]  Brian L. Connelly,et al.  International Diversification: Antecedents, Outcomes, and Moderators , 2006 .

[14]  Robert W. Zmud,et al.  The Nature and Determinants of IT Acceptance, Routinization, and Infusion , 1993, Diffusion, Transfer and Implementation of Information Technology.

[15]  M. Mcclellan,et al.  Uncertainty, health-care technologies, and health-care choices. , 1995, The American economic review.

[16]  Christopher J. Koenig,et al.  Web-based PTSD training for primary care providers: a pilot study. , 2014, Psychological services.

[17]  M. Terziovski Innovation practice and its performance implications in small and medium enterprises (SMEs) in the manufacturing sector: a resource‐based view , 2010 .

[18]  David L. Paul,et al.  Collaborative Activities in Virtual Settings: A Knowledge Management Perspective of Telemedicine , 2006, J. Manag. Inf. Syst..

[19]  Henk W. Volberda,et al.  Co-evolution of Firm Absorptive Capacity and Knowledge Environment: Organizational Forms and Combinative Capabilities , 1999 .

[20]  Elizabeth Kendall,et al.  Translating Knowledge into Practice and Policy: The Role of Knowledge Networks in Primary Health Care , 2010, Health information management : journal of the Health Information Management Association of Australia.

[21]  Todd W. Sands,et al.  Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care , 2012, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[22]  Benita M. Cox,et al.  The impact of electronic patient records on workflow in general practice , 2007, Health Informatics J..

[23]  Amer A. Kaissi,et al.  Uncertainty in Health Care Environments: Myth or Reality? , 2004, Health care management review.

[24]  R. G. Fichman,et al.  Editorial Overview---The Role of Information Systems in Healthcare: Current Research and Future Trends , 2011 .

[25]  Tugba Taskaya-Temizel,et al.  Automatic information timeliness assessment of diabetes web sites by evidence based medicine , 2014, Comput. Methods Programs Biomed..

[26]  Hee-Woong Kim,et al.  AIS Electronic Library (AISeL) , 2022 .

[27]  Man Zhang,et al.  Unpacking the effect of IT capability on the performance of export‐focused SMEs: a report from China , 2008, Inf. Syst. J..

[28]  Pei-Chang Wen,et al.  Business concepts of systemic service innovations in e-Healthcare , 2014 .

[29]  Gill Harvey,et al.  Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement , 2014, BMJ quality & safety.

[30]  Carol Stoak Saunders,et al.  Information Processing View of Organizations: An Exploratory Examination of Fit in the Context of Interorganizational Relationships , 2005, J. Manag. Inf. Syst..

[31]  Shaker A. Zahra,et al.  The Net-Enabled Business Innovation Cycle and the Evolution of Dynamic Capabilities , 2002, Inf. Syst. Res..

[32]  J. Gabbay,et al.  Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care , 2004, BMJ : British Medical Journal.

[33]  Florian A. A. Becker-Ritterspach,et al.  Enriching Absorptive Capacity Through Social Interaction , 2011 .

[34]  Grover S. Kearns,et al.  The impact of industry contextual factors on IT focus and the use of IT for competitive advantage , 2004, Inf. Manag..

[35]  U. Lichtenthaler Absorptive Capacity, Environmental Turbulence, and the Complementarity of Organizational Learning Processes , 2009 .

[36]  Paul A. Pavlou,et al.  From IT Leveraging Competence to Competitive Advantage in Turbulent Environments: The Case of New Product Development , 2006, Inf. Syst. Res..

[37]  Morgan Price,et al.  Impact of electronic medical record on physician practice in office settings: a systematic review , 2012, BMC Medical Informatics and Decision Making.

[38]  Paul A. Pavlou,et al.  Understanding the Elusive Black Box of Dynamic Capabilities , 2011, Decis. Sci..

[39]  C. Schoen,et al.  A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. , 2012, Health affairs.

[40]  Louis C. K. Ma,et al.  Routinisation of B2B E-commerce by small firms: A process perspective , 2011, Information Systems Frontiers.

[41]  Ann Dadich,et al.  Healthcare reform: implications for knowledge translation in primary care , 2013, BMC Health Services Research.

[42]  Morgan Price,et al.  Adopting electronic medical records: are they just electronic paper records? , 2013, Canadian family physician Medecin de famille canadien.

[43]  Balaji R. Koka,et al.  The Reification of Absorptive Capacity: A Critical Review and Rejuvenation of the Construct , 2006 .

[44]  Varun Grover,et al.  Types of Information Technology Capabilities and Their Role in Competitive Advantage: An Empirical Study , 2005, J. Manag. Inf. Syst..

[45]  Guy Paré,et al.  Review Paper: Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base , 2007, J. Am. Medical Informatics Assoc..

[46]  S. Zahra,et al.  Absorptive Capacity: A Review, Reconceptualization, and Extension , 2002 .

[47]  Monideepa Tarafdar,et al.  Understanding the influence of information systems competencies on process innovation: A resource-based view , 2007, J. Strateg. Inf. Syst..

[48]  Deepalika Chakravarty,et al.  Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings , 2012, Int. J. Medical Informatics.

[49]  Jesse C. Crosson,et al.  Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices , 2007, The Annals of Family Medicine.

[50]  Miriam J. Metzger,et al.  Using Web 2.0 Technologies to Enhance Evidence-Based Medical Information , 2011, Journal of health communication.

[51]  Paul A. Pavlou,et al.  IT-Enabled Business Capabilities for Turbulent Environments , 2008, MIS Q. Executive.

[52]  Robert C Geibert,et al.  Using Diffusion of Innovation Concepts to Enhance Implementation of an Electronic Health Record to Support Evidence‐based Practice , 2006, Nursing administration quarterly.

[53]  Yi-Hao Weng,et al.  Increasing utilization of Internet-based resources following efforts to promote evidence-based medicine: a national study in Taiwan , 2013, BMC Medical Informatics and Decision Making.

[54]  Kevin Zhu,et al.  The Complementarity of Information Technology Infrastructure and E-Commerce Capability: A Resource-Based Assessment of Their Business Value , 2004, J. Manag. Inf. Syst..

[55]  Xiaojun Zhang,et al.  "Doctors Do Too Little Technology": A Longitudinal Field Study of an Electronic Healthcare System Implementation , 2011, Inf. Syst. Res..

[56]  Amar K. Das,et al.  Innovation in healthcare intelligence: cross-sector convergence beyond electronic medical records. , 2011, American journal of preventive medicine.

[57]  Viswanath Venkatesh,et al.  Bridging the Qualitative-Quantitative Divide: Guidelines for Conducting Mixed Methods Research in Information Systems , 2013, MIS Q..

[58]  Iestyn Williams,et al.  Organizational readiness for innovation in health care: some lessons from the recent literature , 2011, Health services management research.

[59]  Jean Robson,et al.  Web-based learning strategies in combination with published guidelines to change practice of primary care professionals. , 2009, The British journal of general practice : the journal of the Royal College of General Practitioners.

[60]  A. Kothari,et al.  Lessons from the business sector for successful knowledge management in health care: A systematic review , 2011, BMC health services research.

[61]  Linda Casebeer,et al.  Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants , 2010, BMC medical education.

[62]  Robert G. Fichman,et al.  Going Beyond the Dominant Paradigm for Information Technology Innovation Research: Emerging Concepts and Methods , 2004, J. Assoc. Inf. Syst..

[63]  Vijay Gurbaxani,et al.  A process oriented framework for assessing the business value of information technology , 1995, DATB.

[64]  Richard Makadok Toward a synthesis of the resource‐based and dynamic‐capability views of rent creation , 2001 .

[65]  Ivo Abraham,et al.  Promoting evidence-based management of anemia in cancer patients: concurrent and discriminant validity of RESPOND, a web-based clinical guidance system based on the EORTC guidelines for supportive care in cancer , 2010, Supportive Care in Cancer.

[66]  Simon de Lusignan,et al.  Viewpoint Paper: e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice , 2006, J. Am. Medical Informatics Assoc..

[67]  Robert F. DeVellis,et al.  Uncertainty and Professional Work: Perceptions of Physicians in Clinical Practice , 1992, American Journal of Sociology.

[68]  L. Sommers,et al.  Practice Inquiry: Uncertainty Learning in Primary Care Practice , 2013 .

[69]  Paul K J Han,et al.  Varieties of uncertainty in health care: a conceptual taxonomy. , 2011, Medical decision making : an international journal of the Society for Medical Decision Making.

[70]  V. Reed,et al.  Improving information management in primary care: the proof is in the pudding. , 2008, Informatics in primary care.

[71]  S. Stuart,et al.  Web-based Training for Implementing Evidence-Based Management of Postpartum Depression , 2009, The Journal of the American Board of Family Medicine.

[72]  Neil Skolnik,et al.  A View from the Trenches: Primary Care Physicians on Electronic Health Records , 2011 .

[73]  Shu Han,et al.  Changing the Competitive Landscape: Continuous Innovation Through IT-Enabled Knowledge Capabilities , 2010, Inf. Syst. Res..

[74]  Christine Nadel,et al.  Case Study Research Design And Methods , 2016 .

[75]  John Doucette,et al.  Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries , 2009, Int. J. Medical Informatics.

[76]  Morgan Price,et al.  Knowledge Translation in eHealth: Building a Virtual Community , 2013, ITCH.

[77]  Michael R. Wade,et al.  The Resource-Based View and Information Systems Research: Review, Extension, and Suggestions for Future Research , 2004, MIS Q..

[78]  Richard L. Daft,et al.  Learning the Craft of Organizational Research , 1983 .

[79]  Peter Y. T. Sun,et al.  An Examination of the Relationship between Absorptive Capacity and Organizational Learning, and a Proposed Integration , 2008 .

[80]  Phil Aponte,et al.  Impact of an EHR-Based Diabetes Management Form on Quality and Outcomes of Diabetes Care in Primary Care Practices , 2015, American journal of medical quality : the official journal of the American College of Medical Quality.

[81]  Elizabeth Davidson,et al.  An organizational learning perspective on the assimilation of electronic medical records among small physician practices , 2007, Eur. J. Inf. Syst..

[82]  J. Osheroff,et al.  Clinical Decision Support Systems : State of the Art , 2009 .

[83]  Danny Miller,et al.  Psychological and Traditional Determinants of Structure. , 1986 .

[84]  Andrea Ordanini,et al.  How does the application of an IT service innovation affect firm performance? A theoretical framework and empirical analysis on e-commerce , 2010, Inf. Manag..

[85]  D. Leonard-Barton CORE CAPABILITIES AND CORE RIGIDITIES: A PARADOX IN MANAGING NEW PRODUCT DEVELOPMENT , 1992 .

[86]  Constance E. Helfat,et al.  Untangling dynamic and operational capabilities: strategy for the (n)ever-changing world , 2011 .

[87]  Guy Paré,et al.  Improving performance in medical practices through the extended use of electronic medical record systems: a survey of Canadian family physicians , 2015, BMC Medical Informatics and Decision Making.

[88]  Sharon E. Straus,et al.  The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence , 2011, J. Am. Medical Informatics Assoc..

[89]  Sue Bennett,et al.  Usefulness of a virtual community of practice and web 2.0 tools for general practice training: experiences and expectations of general practitioner registrars and supervisors. , 2013, Australian journal of primary health.

[90]  Ritu Agarwal,et al.  Evolving Work Routines: Adaptive Routinization of Information Technology in Healthcare , 2011, Inf. Syst. Res..

[91]  Dennis Lee,et al.  A Knowledge Translation Project on Best Practices in End-of-life Care , 2015, ITCH.

[92]  Simon de Lusignan,et al.  The Primary Care National electronic Library for Health (NeLH-PC): a pilot of information-centred knowledge management for primary care - www.nelh-pc.nhs.uk , 2002 .

[93]  A. Ghosh,et al.  On the challenges of using evidence-based information: the role of clinical uncertainty. , 2004, The Journal of laboratory and clinical medicine.

[94]  N. Carter,et al.  Small firm adaptation: responses of physicians' organizations to regulatory and competitive uncertainty. , 1990, Academy of Management journal. Academy of Management.

[95]  Kelly Grindrod,et al.  Advancing knowledge translation in primary care. , 2012, Canadian family physician Medecin de famille canadien.

[96]  S. Goldman,et al.  U.S. postmarketing pharmacovigilance compliance in the midst of regulatory uncertainty. , 2007, Food and drug law journal.

[97]  Daniel A. Levinthal,et al.  ABSORPTIVE CAPACITY: A NEW PERSPECTIVE ON LEARNING AND INNOVATION , 1990 .

[98]  Ben Skinner,et al.  Web alert: evidence-based clinical summaries. , 2008, Quality in primary care.

[99]  Louis Raymond,et al.  International Journal of Information Management Information Management for the Internationalization of Smes: an Exploratory Study Based on a Strategic Alignment Perspective , 2022 .

[100]  A. Milat,et al.  How can knowledge exchange portals assist in knowledge management for evidence-informed decision making in public health? , 2014, BMC Public Health.

[101]  R. Krishnan The Role of Information Systems in Healthcare : Current Research and Future Trends , 2011 .

[102]  Fakhraddin Maroofi,et al.  STRATEGIC KNOWLEDGE MANAGEMENT, INNOVATION AND PERFORMANCE , 2013 .

[103]  W. Chismar,et al.  The interaction of institutionally triggered and technology-triggered social structure change: an investigation of computerized physician order entry , 2007 .

[104]  Erwin P. Gianchandani Toward smarter health and well-being: an implicit role for networking and information technology , 2011, J. Inf. Technol..

[105]  Detmar W. Straub,et al.  Riding the Wave: Past Trends and Future Directions for Health IT Research , 2012 .

[106]  Gillian D Sanders,et al.  Enabling health care decisionmaking through clinical decision support and knowledge management. , 2012, Evidence report/technology assessment.

[107]  Daniel Robey,et al.  Explaining changes in learning and work practice following the adoption of online learning: a human agency perspective , 2008, Eur. J. Inf. Syst..

[108]  Davide Nicolini,et al.  Managing Knowledge in the Healthcare Sector: A Review , 2008 .

[109]  Michael L. Tushman,et al.  Information Processing as an Integrating Concept in Organizational Design. , 1978 .

[110]  Albert H. Segars,et al.  Knowledge Management: An Organizational Capabilities Perspective , 2001, J. Manag. Inf. Syst..

[111]  Gerd Antes,et al.  Evidence-based medicine and Web 2.0: friend or foe? , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[112]  Surendra Sarnikar,et al.  Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems - Literature Review and Research Issues for Information Systems , 2010, Commun. Assoc. Inf. Syst..

[113]  Galder Abos Mendizabal,et al.  HOBE+, a case study: a virtual community of practice to support innovation in primary care in Basque Public Health Service , 2013, BMC Family Practice.

[114]  M. Wade,et al.  Review: the resource-based view and information systems research: review, extension, and suggestions for future research , 2004 .

[115]  Raynald Pineault,et al.  Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up , 2014, BMC Health Services Research.

[116]  Daniel C. Smith,et al.  Cross-Functional Product Development Teams, Creativity, and the Innovativeness of New Consumer Products , 2001 .

[117]  R. Duncan Characteristics of Organizational Environments and Perceived Environmental Uncertainty. , 1972 .

[118]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[119]  Mitchel B Harris,et al.  Clinical uncertainty at the intersection of advancing technology, evidence-based medicine, and health care policy. , 2014, JAMA surgery.

[120]  Devin M Mann,et al.  Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial. , 2013, JAMA internal medicine.

[121]  Constance E. Helfat,et al.  The dynamic resource-based view: capability lifecycles , 2003 .

[122]  Andrew Burton-Jones,et al.  From Use to Effective Use: A Representation Theory Perspective , 2013, Inf. Syst. Res..

[123]  Samuel B. Bacharach,et al.  Organizational Theories: Some Criteria for Evaluation , 1989 .

[124]  Yolande E. Chan,et al.  Knowledge strategy typologies: defining dimensions and relationships , 2011 .

[125]  Bita A. Kash,et al.  Leadership, culture, and organizational technologies as absorptive capacity for innovation and transformation in the healthcare sector: A framework for research , 2013 .

[126]  Jay R. Galbraith Designing Complex Organizations , 1973 .