Healthcare Information Systems Research: Who is the Real User?

Introduction

Information systems continue to make inroads into the healthcare industry as more of those in medicine adopt computer technologies (Goldschmidt, 2005; T. Huston & Huston, 2000; Khoumbati, Themistocleous, & Irani, 2006). Innovative technologies support healthcare by maintaining or reducing costs, distributing care to geographically distant patients, and providing consulting specialists where expertise is limited or not available (Field, 1996; LeRouge, Hevner, & Collins, 2007; Login & Areas, 2007). Emphasizing the needs and abilities of those who are using the technology improves the quality of health information systems research.

Crafting Information Systems (IS) research for the healthcare context is an important endeavor. However, IS researchers must be accurate when identifying individual roles (Lamb & Kling, 2003 ; Reponen, 1994), the setting context, and postulating generalizability (Avgerou, 2001; DeLone & McLean, 2003; Rawstorne, Jayasuriya, & Caputi, 2000). One of the most important principles for IS researchers is “know your user” (Norman, 2005). This principle should also apply to those performing healthcare information systems research. However, this is often not the case.

Much of IS theory is rooted within the organization, its business processes, and stakeholders (Ginsberg & Venkatraman, 1985; Magni & Pennarola, 2008; Massa & Testa, 2008; Van de Ven, 2005). Freeman defines a stakeholder as “any group or individual who can affect or is affected by the achievement of the organization's objectives” (Freeman, 1984). Earlier IS research related to stakeholders focused on IS failures (Lyytinen & Hirschheim, 1988), IS planning (Ruohonen, 1991), and implementation of strategic information systems (Galliers, 1991). More recently, focus has been on information systems use, satisfaction, and acceptance.

In order to understand “who really counts”, we need to systematically evaluate stakeholder relationships (Mitchell, Agle, & Wood, 1997). IS stakeholders within a business context generally fall within one of three groups – users, managers, or IS professionals. Although this distinction is fairly clear in healthcare administration (the business side of healthcare), it is not nearly as clear-cut in the patient healthcare setting.

Hospitals, emergency rooms, and laboratories are very different from the normal “business” environment, and healthcare stakeholders vary considerably in the role they play (patient, attending physician, specialist, intern, resident, nurse, clinician, administrator, etc.). Depending upon the situation, any or all of these stakeholders can be users of a healthcare IS system. Therefore, definitions originating from the business environment involving business users and processes may not apply in the healthcare setting. For example, attempting to apply an IS theory such as the Technology Acceptance Model (TAM) to telemedicine requires that the investigator realize the differences in stakeholders. All stakeholders are not users. A physician who reads a report generated by a clinician that operated some technology is not the “user” of the technology. It would therefore be inappropriate to survey the physician’s user acceptance or perceptions of usability of the technology. The clinician, not the physician, is the “user”. In addition, a patient who obligingly reports for an examination and passively participates in a tele-video consultation is not a “user”. The technician who operates the equipment is the user, and the technician’s acceptance of the technology is important to IS researchers.