Implementation through force or Measure? How Institutional pressures Shape National eHealth Implementation Programs

Theoretical contributions on ‘user resistance’ have recently received increasing attention with regards to explaining the failed integration of various types of information systems. Unlike the yet more widespread technology acceptance theories, user resistance offers an alternative view to systemrelated antecedents by taking into account antecedents at the level of the user and their perceived organizational environment. However, previous models have ignored the possible influence of institutional pressures, namely coercive, mimetic and normative pressure, on an individual user’s decision to resist a technology. These are particularly applicable in national IS implementation programs like e.g. large-scale eHealth programs, where factors outside the organization, such as government pressure or public opinion, affect user behaviour. Our study focuses on the introduction of the German Electronic Health Card, an eHealth program, which has been resisted by resident medical doctors for years. The authors introduce an extended ‘Status Quo Bias Model’ and test it amongst a sample of 351 German doctors examining the effects of coercive, mimetic and normative pressures on resistance to this eHealth program. We add a quantitative analysis to the literature on national eHealth programs and user resistance theory, two areas of study, which are predominantly based on findings from case study data.