ABSTRACT

While considerable literature has addressed the separate use of health information systems, limited research has examined how the use of one system changes following the implementation of another. We address this gap in the literature by developing and testing hypotheses about substitution and complementarity in physicians’ use of health information exchange (HIE), which merges patient data from multiple sources, following the implementation of a local electronic medical record (EMR) system. The hypotheses are anchored in theories foundational to understanding the motivation for information seeking behaviour. The hypotheses are tested with unique data, recorded in system log files, that describe HIE use by physicians in an emergency department before and after EMR implementation. The findings confirm that system use is characterised by substitution when it is defined dichotomously as whether the system is accessed or not (lower HIE access rates after EMR implementation) and by complementarity when it is defined as the extent of system use (higher volume and duration of HIE use after EMR implementation). Our findings suggest that the information seeking literature has underestimated the explanatory value of the cost-benefit approach and the occurrence of complementarity in system use because of its overreliance on a narrow definition of use.

摘要

尽管有大量文献讨论了卫生信息系统的单独使用，但有限的研究研究了一个系统的使用如何随着另一个系统的实施而变化。我们通过开发和测试关于医生使用健康信息交换 (HIE) 的替代和互补性的假设来解决文献中的这一空白，该假设在实施本地电子病历 (EMR) 系统后合并来自多个来源的患者数据。这些假设以理解信息寻求行为动机的基础理论为基础。这些假设使用记录在系统日志文件中的独特数据进行测试，这些数据描述了急诊科医师在实施 EMR 之前和之后的 HIE 使用情况。研究结果证实，当系统使用被二分法定义为系统是否被访问（EMR 实施后 HIE 访问率较低）时，系统使用的特征是替代，而当系统使用的程度被定义为系统使用的程度时，系统使用的特征是互补（更高的数量和持续时间EMR 实施后的 HIE 使用）。我们的研究结果表明，由于过度依赖狭义的使用定义，信息搜索文献低估了成本效益方法的解释价值和系统使用中互补性的发生。