Organizational factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework

OBJECTIVE The paper presents an application of the "Fit between Individuals, Task and Technology" (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain. METHOD The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete. RESULTS The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use. CONCLUSION The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.

[1]  Ritu Agarwal,et al.  Are Individual Differences Germane to the Acceptance of New Information Technologies , 1999 .

[2]  Ephraim R. McLean,et al.  Information Systems Success: The Quest for the Dependent Variable , 1992, Inf. Syst. Res..

[3]  Dimitrios G. Katehakis,et al.  An architecture for regional health information networks addressing issues of modularity and interoperability , 2005 .

[4]  Dohoon Kim,et al.  Key functional characteristics in designing and operating health information websites for user satisfaction: An application of the extended technology acceptance model , 2007, Int. J. Medical Informatics.

[5]  Paul Jen-Hwa Hu,et al.  Investigating healthcare professionals' decisions to accept telemedicine technology: an empirical test of competing theories , 2002, Inf. Manag..

[6]  Dale Goodhue,et al.  Understanding user evaluations of information systems , 1995 .

[7]  D. R. Dixon,et al.  The behavioral side of information technology , 1999, Int. J. Medical Informatics.

[8]  Jonathan M. Teich,et al.  The impact of computerized physician order entry on medication error prevention. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[9]  Jeffrey K. Liker,et al.  PERSPECTIVES ON TECHNOLOGY AND WORK ORGANIZATION , 1999 .

[10]  Fred D. Davis,et al.  User Acceptance of Computer Technology: A Comparison of Two Theoretical Models , 1989 .

[11]  T. Mexia,et al.  Author ' s personal copy , 2009 .

[12]  E. Leisch,et al.  Ics-forth 1996 an Architectural Framework for the Integration of Geographically Distributed Heterogeneous Autonomous Medical Information Systems an Architectural Framework for the Integration of Geographically Distributed Heterogeneous Autonomous Medical Information Systems , 1996 .

[13]  Manolis Tsiknakis,et al.  WebOnCOLL: medical collaboration in regional healthcare networks , 1997, IEEE Transactions on Information Technology in Biomedicine.

[14]  I. Ajzen.  The theory of planned behavior , 1991 .

[15]  Y. Han,et al.  Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System , 2005, Pediatrics.

[16]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[17]  P. Maurette.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[18]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[19]  C. Bailey.  Medication Errors and Adverse Drug Events in Pediatric Inpatients , 2002 .

[20]  Hagop S. Mekhjian,et al.  Immediate benefits realized following implementation of physician order entry at an academic medical center. , 2002, Journal of the American Medical Informatics Association : JAMIA.

[21]  W. King,et al.  The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. , 2003, Pediatrics.

[22]  Fred D. Davis,et al.  A Theoretical Extension of the Technology Acceptance Model: Four Longitudinal Field Studies , 2000, Management Science.

[23]  Manolis Tsiknakis,et al.  Delivering a Lifelong Integrated Electronic Health Record Based on a Service Oriented Architecture , 2007, IEEE Transactions on Information Technology in Biomedicine.

[24]  A. Potts,et al.  Computerized physician order entry and medication errors in a pediatric critical care unit. , 2004, Pediatrics.

[25]  M Berg,et al.  Integrating Quantitative and Qualitative Methods in Patient Care Information System Evaluation , 2003, Methods of Information in Medicine.

[26]  Barbara D. Klein,et al.  User evaluations of IS as surrogates for objective performance , 2000, Inf. Manag..

[27]  Manolis Tsiknakis,et al.  An open, component-based information infrastructure for integrated health information networks , 2002, Int. J. Medical Informatics.

[28]  M Fato,et al.  JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the VR Tool). , 2004, Studies in health technology and informatics.

[29]  Suzanne Rivard,et al.  A Multilevel Model of Resistance to Information Technology Implementation , 2005, MIS Q..

[30]  E. Rogers,et al.  Diffusion of innovations , 1964, Encyclopedia of Sport Management.

[31]  Manolis Tsiknakis,et al.  Lessons Learned from PICNIC. , 2005, Studies in health technology and informatics.

[32]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[33]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[34]  S C Orphanoudakis,et al.  Pre-hospital health emergency management as an integrated service of the Regional Health Telematics Network of Crete. , 1997, Studies in health technology and informatics.

[35]  Diane M. Strong,et al.  Extending the technology acceptance model with task-technology fit constructs , 1999, Inf. Manag..

[36]  Ritu Agarwal,et al.  The Role of Innovation Characteristics and Perceived Voluntariness in the Acceptance of Information Technologies , 1997 .

[37]  Dale Goodhue,et al.  Task-Technology Fit and Individual Performance , 1995, MIS Q..

[38]  Abha Agrawal,et al.  Factors associated with improved completion of computerized clinical reminders across a large healthcare system , 2007, Int. J. Medical Informatics.

[39]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005 .

[40]  Gilad J. Kuperman,et al.  Synthesis of Research Paper: A Consensus Statement on Considerations for a Successful CPOE Implementation , 2003, J. Am. Medical Informatics Assoc..

[41]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[42]  Manolis Tsiknakis,et al.  Preliminary results from the deployment of integrated teleconsultation services in rural Crete , 2001, Computers in Cardiology 2001. Vol.28 (Cat. No.01CH37287).

[43]  Jen-Her Wu,et al.  Mobile computing acceptance factors in the healthcare industry : A structural equation model , 2006 .

[44]  Chris Sauer,et al.  Lessons from a failed information systems initiative: issues for complex organisations , 1999, Int. J. Medical Informatics.

[45]  S C Orphanoudakis,et al.  A framework for the integration of distributed autonomous healthcare information systems. , 1997, Medical informatics = Medecine et informatique.

[46]  Manolis Tsiknakis,et al.  Innovative Practices in the Emergency Medical Services in Crete , 2005 .

[47]  Manolis Tsiknakis,et al.  Implementing a Regional Health Information Network: Impact on Health Care Performance and the Management of Change , 2005 .

[48]  이훈,et al.  지각된 유용성(Perceived Usefulness)의 영향분석 , 2004 .

[49]  Manolis Tsiknakis,et al.  Learning effect of a novel interactive basic life support CD: the JUST system. , 2004, Resuscitation.

[50]  Marino Menozzi,et al.  Information access at the point of care: what can we learn for designing a mobile CPR system? , 2004, Int. J. Medical Informatics.

[51]  Fred D. Davis.  User Acceptance of Information Technology: System Characteristics, User Perceptions and Behavioral Impacts , 1993, Int. J. Man Mach. Stud..

[52]  Viswanath Venkatesh,et al.  Creation of Favorable User Perceptions: Exploring the Role of Intrinsic Motivation , 1999, MIS Q..

[53]  Manolis Tsiknakis,et al.  An eHealth platform for instant interaction among health professionals , 2003, Computers in Cardiology, 2003.

[54]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[55]  D. Bates,et al.  Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. , 1997, Critical care medicine.

[56]  Michael G. Morris,et al.  User Acceptance of Information Technology: Theories and Models , 1996 .

[57]  Nina Lundberg,et al.  IT in Healthcare - Artefacts, Infrastructures and Medical Practices , 2000 .

[58]  Robyn Tamblyn,et al.  Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population , 2008, Int. J. Medical Informatics.

[59]  Elske Ammenwerth,et al.  BMC Medical Informatics and Decision Making , 2022 .

[60]  A. Adam.  Whatever happened to information systems ethics? Caught between the devil and the deep blue sea , 2004 .

[61]  E. Rogers.  Diffusion of Innovations, Fourth Edition , 1982 .

[62]  Geoff Walsham,et al.  Implementation of Health Care Information Systems: Key Factors and the Dynamics of Change , 2003 .

[63]  Rainu Kaushal,et al.  Technology Evaluation: Return on Investment for a Computerized Physician Order Entry System , 2006, J. Am. Medical Informatics Assoc..

[64]  Manolis Tsiknakis,et al.  Developing manufacturer-independent components for ECG viewing and for data exchange with ECG devices: can the SCP-ECG standard help? , 2001, Computers in Cardiology 2001. Vol.28 (Cat. No.01CH37287).

[65]  Jonathan M. Teich,et al.  The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment , 1999, Int. J. Medical Informatics.