Understanding Contingencies Associated with the Early Adoption of Customer-Facing Web Portals

Web-based portals extend many convenient and collaborative capabilities to consumers and are being adopted by small firms with ever greater frequency, especially in the context of health care. The early adoption of patient portals by ambulatory-care clinics (outpatient health providers) presents a unique opportunity to more fully understand the characteristics of supply-side adopters in a context where firms (ambulatory-care clinics) are extending digital services to consumers (patients). Using diffusion of innovations literature and contingency theory as the theoretical base, we expand upon the firm characteristics traditionally considered to be predictors of adoption (e.g., firm size, slack resources, competition, capabilities, and management support) and examine how demand contingencies, service contingencies, and learning externality contingencies affect patient portal adoption by ambulatory-care clinics in the United States. We find that early adopters often have a structure in place that provides support for innovations (e.g., part of integrated delivery systems), as would be predicted by diffusion of innovation theory. We also find, though, that service contingencies associated with continuity of care, learning externality contingencies associated with local influences, and select demand contingencies associated with the local market significantly influence patient portal adoption decisions. Our findings suggest that the adoption and diffusion of patient portals may be affected by more than traditionally considered "dominant" firm characteristics and provide insights into how such customer-facing systems may be affected by contingent factors.