M-health infusion by healthcare practitioners in the national health services (NHS)

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Abstract

Despite substantial research on IT implementation in the IS field, the healthcare industry has historically been considered a technological laggard and lacks direction on how to successfully infuse new technological innovations within individuals work practices. Theoretically, m-health technologies, if infused in work practices can potentially enhance the quality of healthcare delivery. The question remains as to whether practitioners' performance significantly improves and individual knowledge is enhanced through the infusion of these technologies. While a significant amount of extant literature focuses on initial technology adoption and acceptance, there remains a dearth of literature which focuses on the long term utilisation and associated benefits. This paper addresses this gap in extant literature through the development and testing of a conceptual model, exploring determinants of individual infusion of m-health technologies and their subsequent outcomes. This study has several implications for both theory and practice.

Highlights

► Develops a model to explain an individual's infusion of m-health technologies. ► Task, user and technology characteristics explain infusion of m-health technologies. ► Infusion of m-health technologies improves practitioners' performance. ► Infusing m-health technologies does not directly create knowledge. ► Infusing m-health technologies facilitate medical learning.

Introduction

In healthcare, organisations continually strive to improve patient care [30]. Information Technology (IT) is perceived as being an enabler of more efficient and effective healthcare delivery [15]. Yet, despite substantial research on IT implementation in the Information Systems (IS) and medical informatics fields, the healthcare industry remains a technological laggard [3] with a dearth of research focusing on how to infuse IT technologies into individuals' work practices in order to realise substantial benefits. The underlying premise behind this ‘lag’ is that information technologies are often under-utilised following adoption [19]. For instance, a study conducted in the Geneva University Hospital [48] with mobile handheld devices found that usage of the devices declined after the initial phase of implementation. It is therefore important to investigate post-adoption use of any technological innovation to fully appreciate long term success of IT technologies [41].

Cooper and Zmud [8] identify six stages of IT implementation. Analysis of the literature pertaining to implementation of mobile technologies (Table 1) reveals that extant research predominately focuses on the first five stages. Stage six—namely, infusion—remains one of the least studied facets of IT post-adoption, not only in the mobile literature but also in the generic IS literature ([32], [45]). Infusion is a distinctive feature in the Cooper and Zmud [8] model, which reflects the extent to which an IT technology is fully embedded in an individual's work system [10].

Organisations worldwide invest heavily in the implementation of technological innovations. Engagements in Swedish e-health initiatives cost the healthcare sector approximately €700 million annually [29]. If such technological innovations are not infused within an individual's work practice, technology will ultimately fail, as individuals do not realise the full potential of a technological innovation through comprehensive and integrated use. Consequently, such technological innovations may deliver only limited benefits. These limited benefits, according to [40], may not compensate for what is usually a costly and difficult implementation process.

Section snippets

Infusion of m-health technologies

The application of mobile technologies within healthcare, namely mobile-health or m-health, has revolutionised the delivery of healthcare services as mobile technologies support the provision and capture of patient-related information at the point-of-care [4]. In this study an m-health technology refers to “any mobile handheld device and applications which run on that device to support the user” [34].

The documented potential of m-health technologies is widely purported. These include how

Conceptual model development

In developing a conceptual model to explore determinants and outcomes of m-health infusion, pertaining to individuals, the researchers identified and analysed a number of existing models pertaining to infusion (e.g. [40], [21], [37], [52]). However analysis of existing infusion models revealed their unsuitability for investigating individual infusion, with such models primarily focused on infusion of technologies at an organisational level. For example, organisational readiness, external

Conceptual model and construct definition

An analysis of the m-health infusion literature revealed four key technology characteristics which have an impact on m-health infusion (Table 2). Adapted from [1], [14], technology characteristics refer to specific features, functionality, or usability of a technology that can affect its infusion by target users. These characteristics have been shown to influence other phases of IT implementation but have received little attention in the infusion literature.

Infusion distinguishes itself from

Research methodology

The objective of this research is to explore the infusion of m-health technologies among medical practitioners and the resultant impact of infusion on knowledge creation and individual performance. The case study approach is one of the most commonly used research methods in the IS field ([2], [9]). It aims to obtain an in-depth understanding of the phenomenon and its context [5]. Case studies enable researchers to investigate pre-defined phenomena without explicit control or manipulation of any

Findings and discussions

This section presents the findings of this study and discusses its implications for the a priori conceptual model. Findings reveal that the conceptual model developed from extant literature is limited in explaining infusion of m-health technologies by individuals and by extension individual performance. Therefore, a revised model is derived and presented (Figure 2).

Extant literature characterised the factors which impact upon m-health infusion as being technological characteristics. Analysis

Emergent categories

Two additional categories emerged from the coding process including task characteristics and user characteristics. Table 3 provides an overview of our findings in terms of the emergent determinants and their associated category.

Technology characteristics

Medical practitioners indicate that system quality dimensions such as availability, technology maturity and portability of m-health technologies are pertinent for individual infusion. Each dimension is discussed in more detail in the subsequent sections.

User characteristics

Various medical practitioners interviewed indicate that content quality dimensions such as traceability—considered as “Big Brother like”—is important for delivering healthcare services. Attitudes towards this ‘Big Brother Surveillance’ ranged from “it scares me” (nurse) to “I think when you are looking after people you got to be a bit ‘Big Brother’—you got to be tight” (dietician). Comments from one nurse indicate that the “only thing that makes me as diligent as I am of using it, is a scare

Task characteristics

Three dimensions are discussed in this section namely, time-criticality, interdependence and mobility.

Extent of infusion

This section will discuss integrative and exploratory use (infusion). Analysis revealed that individual users utilise the m-health technology at various levels of sophistication. As a result, the revised model will now merge integrative and exploratory use into ‘extent of infusion’. The following section will discuss our findings relating to infusion.

Results indicate that integrative use is dominant at the infusion phase of m-health technology implementation. Medical practitioners use the

Individual performance

This section will discuss the outcomes of m-health infusion. Analysis revealed that individual performance is significantly improved through the infusion of m-health technologies. However, findings revealed that infusion of m-health technologies did not enhance individual’s knowledge. The following section will discuss our findings relating to these outcomes.

Several categories of benefits emerged from the analysis associated with individual performance through infusion of m-health technologies.

Conclusion

Mobile technologies have been increasingly incorporated into medical practitioners' work practices. Yet actual infusion of such technologies has tended to lag, and the potential benefits of m-health technologies have not been fully realised. This paper develops a model to explain an individual’s infusion of m-health technologies and has implications for both theory and practice. This study identifies three categories (task characteristics, user characteristics and technology characteristics)

Acknowledgement

This research was partially funded by Business Information Systems, Conference Travel Support Scheme, University College Cork, Health Information Systems Research Centre (HISRC), and by the Science Foundation Ireland (SFI) SFI"11/RFP.1/CMS/3338.

References (60)

  • I. Benbasat et al.

    The case research strategy in studies of information systems

    MIS Quarterly

    (1987)
  • D. Burke et al.

    Opening the black box: measuring hospital information technology capability

    Health Care Management Review

    (2004)
  • Burley L Scheepers H, Fisher J. Diffusion of mobile technology in healthcare. In: Proceedings of the Euro mGOV 2005...
  • A. Cavaye

    Case study research: a multi-faceted research approach for IS

    Information Systems Journal

    (1993)
  • K. Charmaz

    Grounded theory: objectivist and constructivist methods

  • D.R. Compeau et al.

    Computer self-efficacy: development of a measure and initial test

    MIS Quarterly

    (1995)
  • R.B. Cooper et al.

    Information technology implementation research: a technology diffusion approach

    Management Science

    (1990)
  • P. Darke et al.

    Successfully completing case study research: combining rigor, relevance and pragmatism

    Information Systems Journal

    (1998)
  • Fadel KJ. Infusion of information systems: the role of adaptation and individual cognitions. PhD dissertation. The...
  • M.N. Frolick et al.

    Assessing m-commerce opportunities

    Information Systems Management

    (2004)
  • R.D. Galliers

    Choosing information systems research approaches. In information systems research: issues

  • B.G. Glaser et al.

    The discovery of grounded theory: strategies for qualitative research

    (1967)
  • D.L. Goodhue et al.

    Task-technology fit and individual performance

    MIS Quarterly

    (1995)
  • Hoehle H, Scornavacca E. Unveiling experts perceptions towards the characteristics and value propositions of mobile...
  • C.-T. Hsieh

    Mobile commerce: assessing new business opportunities

    Communications of the International Information Management Association

    (2007)
  • M.-C. Hung et al.

    An exploratory study on the continuance of mobile commerce: an extended expectation-confirmation model of information system use

    International Journal of Mobile Communications

    (2007)
  • J.S. Jasperson et al.

    A comprehensive conceptualization of post-adoptive behaviors associated with information technology enabled work systems

    MIS Quarterly

    (2005)
  • A. Kishore et al.

    Reconceptualizing innovation compatibility as organisational alignment in secondary it adoption contexts: an investigation of software reuse infusion

    IEEE Transactions on Engineering Management

    (2007)
  • R. Liden et al.

    Task interdependence as a moderator of the relation between group control and performance

    Human Relations

    (1997)
  • M. Limayem et al.

    How habit limits the predictive power of intention: the case of information systems continuance

    MIS Quarterly

    (2007)
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    Funding. This research was partially funded by Business Information Systems, Conference Travel Support Scheme, University College Cork, Health Information Systems Research Centre (HISRC), and by the Science Foundation Ireland (SFI) SFI"11/RFP.1/CMS/3338.

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