title: Investigating the roots of successful IT adoption processes - an empirical study exploring the shared awareness-knowledge of Directors of Nursing and Chief Information Officers.
abstract: BACKGROUND
  The majority of health IT adoption research focuses on the later stages of the IT adoption process: namely on the implementation phase. The first stage, however, which is defined as the knowledge-stage, remains widely unobserved. Following Rogers' Diffusion of Innovation Theory (DOI) this paper presents a research framework to examine the possible lack of shared IT awareness-knowledge, i.e. an information gradient, of two crucial stakeholders, the Chief Information Officer (CIO) and the Director of Nursing (DoN). This study shall answer the following research questions: (1.) Does this gradient exist? (2.) Which direction does it have? (3.) Are certain health IT (HIT) attributes associated with a potential gradient? (4.) Which determinants of diffusion go along with this gradient?
  
  
  METHODS
  Results of two surveys that focused on the topic "IT support of clinical workflows" from the viewpoint of CIOs and DoNs with corresponding datasets from 75 hospitals were used in a secondary data analysis. The gradient was operationalised by measuring the disagreement of CIOs and DoNs on the availability and implementation status of 29 IT functions. HIT attributes tested were relevance and market penetration of the IT functions, determinants of diffusion were inter-professional leadership and IT service density.
  
  
  RESULTS
  The analysis revealed a significant disagreement on the availability of 9 out of 29 HIT functions. In 23 HIT functions, the CIOs reported a higher implementation status than the DoNs, which pointed to a trend for a unidirectional gradient. The disagreement was significantly lower when the relevance of the IT function was high. Both determinants of diffusion correlated significantly negative with the degree of disagreement.
  
  
  CONCLUSIONS
  This is the first study to empirically examine shared awareness-knowledge of two IT-stakeholders that are crucial for triggering IT adoption on the frontline level in hospitals. It could be shown that a gradient and thus a lack of shared awareness-knowledge existed and was associated with certain factors. In conclusion, hospitals should implement improved cooperation between IT staff and clinicians and IT service density when establishing the prerequisites for successful IT adoption processes.
authors.affiliation: Department of Business Management and Social Sciences, Health Informatics Research Group, Hochschule Osnabrück, P.O. Box 1940, Osnabrück, D-49009, Germany. j.liebe@hs-osnabrueck.de.
authors.forename: J D
authors.initials: JD
authors.lastname: Liebe
authors.affiliation: Department of Business Management and Social Sciences, Health Informatics Research Group, Hochschule Osnabrück, P.O. Box 1940, Osnabrück, D-49009, Germany. j.huesers@hs-osnabrueck.de.
authors.forename: J
authors.initials: J
authors.lastname: Hüsers
authors.affiliation: Department of Business Management and Social Sciences, Health Informatics Research Group, Hochschule Osnabrück, P.O. Box 1940, Osnabrück, D-49009, Germany. u.huebner@hs-osnabrueck.de.
authors.forename: U
authors.initials: U
authors.lastname: Hübner
mesh_terms: D000288:Administrative Personnel / Q000458:organization & administration*; D004059:Diffusion of Innovation; D063025:Health Information Management / Q000458:organization & administration*; D006801:Humans; D008490:Medical Informatics / Q000458:organization & administration*; D009729:Nursing
references.citation: Aust Health Rev. 2000;23(3):176-85
references.pmid: 11186051
references.citation: Stud Health Technol Inform. 2011;169:335-8
references.pmid: 21893768
references.citation: BMJ. 2008 Oct 23;337:a1786
references.pmid: 18948344
references.citation: Stud Health Technol Inform. 2011;169:243-7
references.pmid: 21893750
references.citation: Nurs Adm Q. 2006 Jul-Sep;30(3):203-10
references.pmid: 16878005
references.citation: Int J Med Inform. 2014 Feb;83(2):113-21
references.pmid: 24262068
references.citation: ANS Adv Nurs Sci. 2009 Jul-Sep;32(3):252-79
references.pmid: 19707093
references.citation: Int J Med Inform. 2007 Jan;76(1):22-33
references.pmid: 16478675
references.citation: J Med Syst. 2012 Feb;36(1):241-77
references.pmid: 20703721
references.citation: Appl Clin Inform. 2012 Dec 19;3(4):488-500
references.pmid: 23646093
references.citation: Int J Med Inform. 2014 Jun;83(6):393-405
references.pmid: 24656180
references.citation: J Am Med Inform Assoc. 2003 May-Jun;10(3):229-34
references.pmid: 12626376
references.citation: Soc Sci Med. 1999 Mar;48(5):633-46
references.pmid: 10080364
references.citation: Health Aff (Millwood). 2004 Jul-Aug;23(4):184-90
references.pmid: 15318579
references.citation: Int J Med Inform. 2011 Dec;80(12):828-40
references.pmid: 22014811
references.citation: Milbank Q. 2004;82(4):581-629
references.pmid: 15595944
references.citation: J Healthc Manag. 2009 Sep-Oct;54(5):337-47; discussion 348
references.pmid: 19831118
references.citation: Int J Med Inform. 2013 May;82(5):e73-86
references.pmid: 23146626
references.citation: BMC Med Inform Decis Mak. 2006 Jan 09;6:3
references.pmid: 16401336
references.citation: BMC Med Inform Decis Mak. 2010 Feb 02;10:8
references.pmid: 20122275
references.citation: N Engl J Med. 2009 Apr 16;360(16):1628-38
references.pmid: 19321858
references.citation: J Am Med Inform Assoc. 2009 May-Jun;16(3):291-9
references.pmid: 19261935
references.citation: AMIA Annu Symp Proc. 2006;:982
references.pmid: 17238601
references.citation: BMC Med Inform Decis Mak. 2011 Jun 17;11:42
references.pmid: 21682885
references.citation: Appl Clin Inform. 2014 Feb 12;5(1):92-117
references.pmid: 24734127
references.citation: J Health Serv Res Policy. 2010 Oct;15(4):243-50
references.pmid: 20592046
references.citation: Int J Med Inform. 2003 Mar;69(2-3):235-50
references.pmid: 12810127