Successful Strategies for Implementing Health Information Technol (2).pdf

Section 1: Foundation of the Study

The advancement of health information technology (HIT) continues to reform the

delivery of health care for quality and efficiency. Leaders implement HIT to streamline

processes, reduce service delays, limit fraud, and eliminate unnecessary errors made by

some health care professionals in the discharge of their duties. Thus, HIT positively

affects health care performance through reduced waste and increased profitability (Brunt

& Bowblis, 2014). However, HIT adoption rates among primary care practitioners

(PCPs) is low (Brunt & Bowblis, 2014). The objective of this qualitative multiple case

study was to explore successful strategies PCPs use to implement HIT to improve

primary facility care delivery and profitability.

Background of the Problem

HIT has been a significant part of health care improvement and efficiency

(McCullough, Parente, & Town, 2016). PCPs may reduce the mortality rate and increase

survival of high-risk patients through enhanced monitoring after HIT implementation

such as patients with pneumonia (McCullough et al., 2016). Additionally, HIT provides

one potential avenue to improve both conformance and experiential quality successfully

(Sharma, Chandrasekaran, Boyer, & McDermott, 2016). HIT adoption by health care

practitioners can also improve care cost-efficiency through waste avoidance by

supporting the delivery of accurate and timely health care to all patients (Hu et al., 2015).

Regarding cost efficiency, researchers suggest that opening visit notes to patients

through HIT adoption improves communication and helps patients become more actively

involved in their health and care (Sensmeier, 2016). Adopting HIT serves as information

access and exchange tools necessary to achieve optimal care and patient safety

coordination (Sensmeier, 2014). With the increased implementation and use of HIT,

health care managers can improve care, data standardization, and continue to reduce cost

(Verdon, 2015). Patients may benefit from their own self-management of diabetes

through the adoption of HIT (Or & Tao, 2014).

Although researchers have studied the usability of HIT interventions, the reason

for not using specific behavioral theories remains unclear (Brunt & Bowblis, 2014; Payne

et al., 2016; Sawesi, 2016). Most practitioners find the use of HIT features difficult;

however, the continued support for HIT is because of the benefits, features, and facilities

(Sawesi, 2016). Further, to be a standard in the field of the health care system, the

effectiveness of HIT interventions can be measured based on factors such as (a)

motivation for health behavior change, (b) long-standing adherence, (c) expenditure, (d)

satisfaction, and (e) health outcomes (Sawesi, 2016). Additionally, it is important that the

application of HIT leads to primary health care systems that are more accessible and user

friendly. PCPs who use HIT platforms can enhance patient engagement and improve

health outcomes because patients become more empowered in addressing their own

health concerns (Sawesi, 2016). Patients empowered by information access are more

trusting of their PCP and the broader health care system. This background prompted my

interest to investigate successful strategies primary health care practitioners use to

implement HIT to improve primary facility care delivery and profitability.

Problem Statement

The 21st century adoption and use of HIT had a dramatic impact on the practice

of primary medicine (Payne et al., 2016). Following successful adoption of HIT, primary

care facilities have increased total revenue more than an 8% and improved patient

outcomes (Lee & Choi, 2016). Nevertheless, some PCPs do not experience the benefits of

HIT adoption because of ineffective implementation strategies and guidelines. The

general business problem is that the adoption of HIT among primary care practices is

slow and challenging. The specific business problem is that some PCPs lack successful

strategies to implement HIT to improve primary facility care delivery and profitability.

Purpose Statement

The purpose of this qualitative multiple case study was to explore successful

strategies PCPs use to implement HIT to improve primary facility care delivery and

profitability. The target population comprised PCPs from six primary care facilities

successfully using HIT for daily health care delivery in Queens County, New York. For

the HIT implementation to be considered successful, the PCPs must have (a) confirmed a

postimplementation revenue increase of 8% within two calendar years, and (b) improved

year-over-year patient satisfaction measures. The implication for positive social change is

that successfully implementing HIT could improve primary health care delivery and

facility profitability. Improved primary facility health delivery can include streamlined

patient processes, improved diagnoses efficacy, faster and more consistent assessment

protocols, consistent record keeping, improved patient registration, facilitated patient

record transfer, and immediate access to patient medical records during treatment

continuation. Improved facility revenue includes an increase of 8% or more within 2

years of a successful HIT implementation. Finally, the findings could enable PCPs to

improve patient care by addressing HIT implementation deficiencies.

Nature of the Study

To address the purpose of the study, I chose a qualitative research method.

Qualitative researchers discover common themes from detailed experiences by

identifying the intentions and actions of people (Yin, 2017). To provide insights into the

setting of a problem, qualitative researchers facilitate deep understanding of a

phenomenon through observation, exploration, and interpretation (Park & Park, 2016).

Further, a qualitative approach was appropriate because I did not examine or numerically

measure variables’ relationships or differences.

In this study, I chose the multiple case study design to understand, explore, and

report pragmatic, successful HIT implementation strategies by PCPs. A multiple case

study requires understanding the complexity of an individual case (Park & Park, 2016).

Further, the individual case involves a bounded system investigation of a subject deemed

worthy of analysis (Park & Park, 2016). Using a multiple case study design can help to

understand and report the uniqueness of individual cases through (a) interviews to gather

narrative and testimony; (b) watching to gather observations; (c) searching the germane

written records and artifacts; and (d) exploring the conceptual structure, looking for data

patterns, consistencies, repetitions, and manifestations pertinent to each research question

(Park & Park, 2016).

In contrast to multiple case study design, ethnographic researchers focus on

studying an entire culture of individuals to gain perspectives of their experiences

(Mannay, & Morgan, 2015). I did not intend to study HIT implementation in a cultural

group, making an ethnographic design inappropriate. Further, the primary goal of

phenomenological researchers is to study the human life experience from the view of

those living the phenomenon (Dowden, Gunby, Warren, & Boston, 2014). In contrast, I

gathered information about the successful strategies PCPs use to implement HIT to

improve primary facility care delivery and profitability. Hence, a phenomenological

gathering of information related to participant’s human life experiences would not have

yielded the data to determine successful strategies.

Research Question

What successful strategies do PCPs use to implement HIT to improve primary

facility care delivery and profitability?

Interview Questions

1. What successful strategies have you used to implement HIT to improve

primary facility care delivery and profitability?

2. How did you arrive at these strategies?

3. What challenges did you encounter?

4. How did you overcome these challenges?

5. How did you assess and measure the effectiveness of your HIT

implementation strategies?

6. Based on your experience, what training or policy influenced your

implementation process of these successful strategies?

7. How did you handle and influence internal user and patient acceptability?

8. Based on your experiences and analysis, what contributed to the success of

these strategies?

9. How did you handle and measure pre- and post-implementation efficiency

improvement(s)?

10. What additional information can you share to help others understand the

successful strategies your organization employed to adopt your HIT?

Conceptual Framework

To provide a conceptual framework for this study, I employed the general systems

theory. Systems theory indicates the structure and properties of systems in terms of

relationships from which new properties of wholes emerge. Ludwig von Bertalanffy

introduced general systems theory in 1937; the inspiration behind systems theory is the

idea of a system’s entirety (von Bertalanffy, 1972). Von Bertalanffy (1972) defined a

general system as any theoretical scheme of interest to more than one element. Systems

have differentiation and specialization; for example, the parts made up of elements may

specialize to accomplish particular functions like boundary maintenance, input or output

regulation, and decision-making. Systems theory provides an internally consistent

framework for classifying and evaluating the world (von Bertalanffy, 1972).

I selected general systems theory as the appropriate framework to explore the

complex systems within a primary care facility and to provide strategies for successful

HIT implementation. Viewing the phenomenon through systems theory could help to

explore perceptions of interactive strategies of PCPs to the whole concept of HIT

implementation. Implementing HIT can enhance organizations ability to increase

profitability (Ghobakhoo & Tang, 2014). The general systems theory provided a

framework for the exploration of successful strategies for implementing HIT in primary

care practice.

Operational Definitions

Health information technology (HIT). HIT is a data-driven computer system used

by health care professionals and patients to process and share patient-related data,

information, or knowledge (Pinsonneault et al., 2017).

Primary care practice. A primary care practice is the first point of access to

health care outside of hospitals and involves (a) general practice surgeries, (b) a central

point for care continuity, and (c) facilitates and anticipates interactions between a diverse

range of health care providers (McLeod & Simpson, 2017).

Primary care practitioner (PCP). Health care provider with a focus as the

mainstay of diagnoses, crucial preventive and curative services, and possible referral to

specialist (Galea & Kruk, 2019).

Successful HIT implementation. Operating a functional (meaningful use) HIT

system with little or no error and an increase of 8% or more within 2 years of HIT

implementation (Yen, McAlearney, Sieck, Hefner, & Huerta, 2017).

Assumptions, Limitations, and Delimitations

Assumptions

Study assumptions are unverified facts considered to be true but are necessary for

the research problem (Leedy & Ormrod, 2015). For example, one of the assumptions of

this study was that a researcher must achieve data saturation and involve three or more

participants (see Krueger & Casey, 2014). Second, I assumed that each participant would

understand the interview questions and answer truthfully. Third, I assumed that having

successfully implemented and used HIT in primary care practice, each participant would

provide relevant, important, and substantive information.

Limitations

Limitations of a study are potential weaknesses out of the researcher’s control that

may restrict the intended scope or purpose of the study (Marshall & Rossman, 2016). The

fundamental limitation of qualitative case studies is the small sample size of participants

(Yin, 2017). The potential participants’ bias and ability to answer questions genuinely

may also affect the quality of the research (Saunders, Lewis, & Thornhill, 2016). Further,

one limitation was that participants may be uncomfortable answering specific questions

or hesitate to provide detailed competitive information.

Delimitations

Delimitations are factors that limit the scope and define the boundaries of a study

(Yin, 2017). Delimitations may include geographical location, chosen population, sample

size, and the research questions (Yin, 2017). The scope of this study was delimited to

PCPs who successfully implemented and utilized HIT in Queens, New York. Therefore,

the research outcomes of this study may not be generalizable to physician specialties or

other geographical locations. Additionally, participants were PCPs who successfully

implemented HIT to improve primary facility care delivery and profitability.

Significance of the Study

Contribution to Business Practice

Adoption of HIT by health care practitioners may improve care cost-efficiency

through (a) waste avoidance and (b) supporting the delivery of accurate and timely health

care to all patients (Hu, Ong, Zhu, Liu, & Song, 2015). Thus, health care practitioners’

adoption of HIT may create opportunities to improve care delivery, reduce preventable

medical errors, decrease cost, and increase efficiency and profitability. Study outcomes

may show PCPs and small practice owners effective strategies to facilitate successful HIT

implementation for improved care delivery and increased profits. As sources of

information, and as means to bolster communication accuracy, health organization

information systems, public health surveillance data, strategic needs assessments, and

bioinformatics evidence help administrators to improve health care (Martin & Felix-

Bortolotti, 2014).

Implications for Social Change

Implementation of HIT is an important driver of quality and safety, as highlighted

in a recent study of malpractice claims involving seven different hospitals (Sensmeier,

2016). Health care professionals’ HIT adoption facilitates care coordination through

increased responsiveness, efficiency, security, privacy, and accuracy as well as support

better communication and error reduction (Sensmeier, 2014). This study’s finding could

contribute to positive social change by helping PCPs procure and implement necessary

HIT to improve primary care delivery by reducing wastage and errors affecting the

efficacy of patients’ care. Additional social change includes encouraging a simplified

access to medical reports and ease the flow and transfer of medical information to payers

and patients. With the adoption of HIT, PCPs can rely on faster and more accurate health

information data to offer better diagnoses and enhance treatments for patients.

A Review of the Professional and Academic Literature

Practitioners who implement HIT can make health information directly available

to patients through generally accessible electronic tools such as patient portals, wearable

technology, and mobile applications (Mackert, 2016). However, the direct availability of

this information to patients may be complicated because of insufficient understanding of

HIT privacy and information sharing (Mackert, 2016). For instance, patients with low

health literacy are less likely to use HIT tools (Mackert, 2016). Furthermore, some

patients consider their health information provided through HIT is private (Mackert,

2016). Given the fast-paced evolution of technology, there is a pressing need to further

the understanding of how health literacy relates to HIT application adoption.

Implementation of HIT can provide better health information access to facilitate their

own health management (Mackert, 2016). In this study, I investigated what strategies

PCPs use to successfully implement HIT to improve primary facility care delivery and

profitability. For the HIT implementation to be considered successful, the PCPs must

have (a) confirmed a postimplementation revenue increase of 8% within 2 calendar years

and (b) improved year-over-year patient satisfaction measures. The following literature

review will support the foundation of the study.

Literature Research Strategy

In this qualitative multiple case study, the goal was to explore successful

strategies PCPs use to implement HIT to improve primary facility care delivery and

profitability. Therefore, this literature review includes information on the following

topics: (a) related theories, (b) strategies for implementing HIT in primary care practice,

(f) the future of HIT, (g) HIT and the cloud, and (h) HIT and fraud. Included in this

review are peer-reviewed journals articles published within 5 years of completion of the

study. Article sources included Walden University’s Library, EBSCO Host, ProQuest

Research, Google Scholar, Business Source Complete, Emerald Insight, and Management

Review. Additionally, books and selected American government publications comprised

the sources of information for this literature review.

Theory of Reasoned Action/Theory of Planned Behavior

Ajzen and Fishbein (1980) developed the theory of reasoned action to estimate

discrepancies between behaviors and attitudes. Previously applied to HIT adoption, the

theory of reasoned action is an innovation theory influenced by the additions of different

variables, including user readiness (Lai, 2017). Investigating the motives, attitudes, and

intentions of a specific behavior forms a necessary base in the theory of reasoned action.

Distinct variables in the theory of reasoned action include a buyer’s attitudes, motivation,

and subjective norms. Different variables affect a buyer’s preference such as their

attitudes, motivation, and subjective norms (Joshua et al., 2018). These constructs apply

to choice under the theory of reasoned action.

Ajzen and Fishbein’s theory helps predict the intentions of different individuals to

undertake reasoned actions in their daily life action scenarios. For example, Kanowski et

al. (2017) used the theory of reasoned action in their study concerning why different

individuals use social media to share information. The theory of reasoned action also

applies to studies on coupon usage, ethical behavior, and social commitment (Paul et al.,

2016). Other applications of theory of reasoned action include in brand loyalty, behavior

adoption in the usage of condoms to lower the spread of HIV/AIDS, and road safety.

Researchers affirm that attitudes are highly fundamental in the theory of intended action

(Alexander & Madsen, 2018; Alexander, Madsen, & Newton, 2017; Ko, Wagner, &

Spetz, 2018). Relatedly, the theory of reasoned action aligns with interviewing PCPs to

understand their attitudes toward the adoption of HIT.

Technology Acceptance Model

The technology acceptance model (TAM) is an essential aspect in understanding

the relationship between technology and humans. The TAM encompasses considerations

of human, organizational, and technological factors that obstruct the use and acceptance

of HIT by health care professionals (Hsiao & Chen, 2015). Hsiao and Chen (2015)

further defined the TAM as a fundamental theory of system information because it

promoted the various process stages, including inculcating, acceptance, and utilization of

the recent technological innovations. Thus, the TAM enables users to achieve the

fundamental skills in information literacy (Hsiao & Chen, 2015). However, the

acceptance of IT adoption is a psychological choice individual or organizations make

regarding an IT system (Schwarz, Chin, Hirschheim, & Schwarz, 2014). This aspect is

better understood through both perceived ease of use and perceived usefulness. Perceived

usefulness relates to the degree to which a user believes using a system will enhance his

or her job performance, whereas perceived ease of use refers to the extent to which a user

believes using a particular system will be free of efforts (Falode, 2018).

The modification of the TAM has been applied to technological innovations

(Werasinghe & Hindagolla, 2018). For instance, it is possible to apply the TAM to

technology in social media (Althuizen, 2017). The validation and development of the

TAM are fundamental to the validation and development in ensuring that different

locating systems are enhanced safely (Kwee-Meier et al., 2016).

The TAM is relevant in investigating patients’ acceptance among different

technologies. The use of the TAM in the investigation of the health conditions of patients

ensures that the technology available is properly used in enhancing health care and safety

for the patients. The TAM is fundamental in analyzing the effects of technological

innovation by enhancing safety for patients when the need arises. For example, the TAM

is commonly used in different health care delivery processes and in measuring acceptance

(Moradi & Bayat, 2018).

The TAM is also appropriate to determine how the health professionals are able to

accept and utilize HIT in their practices (Agha, 2014). Information technology links

productivity growth in a wide variety of sectors and HIT is a leading example of

innovation with the potential to transform industry-wide productivity. Conversely, some

PCPs continue to make poorer value addition to the service they provide because of the

lack of HIT adoption and technological improvement (Jha & Bag, 2019). To be able to

properly use technology in the health care system, there must be proper consent from the

patients.

A patient’s behavior about usage depends on factors or variables such as the

perceived ease of use and perceived usefulness. HIT applications, if appropriately

employed, can lead to perceived usefulness of HIT (Sun et al., 2018). Though factors like

cultural differences cause some patients to be less inclined to HIT acceptance, perceived

usefulness and perceived ease of use can be improved by identifying the long-term

benefits associated with HIT (Sun et al., 2018). With HIT systems in place, patients

regardless of age or location can consult their primary care provider without visiting a

facility.

The TAM is one of the strongest and most commonly used models because (a) it

can assist in predicting the usage of technology; (b) offers a description of the impacts of

perceived ease; and (c) can support descriptions of perceived usefulness for behavior

intention, individuals’ attitude, and system usage (Stei & Rossman, 2016). Therefore, the

TAM is useful in explaining, examining, and predicting why some PCPs’ attitudes and

beliefs influence their acceptance or rejection of HIT.

Diffusion of Innovation Theory

Diffusion is a process by which innovation is transmitted among different

members of a given social system through different communication channels (De

Almeida et al., 2016). Additionally, diffusion can be described as the process of

communication through which the aspect of an innovation (e.g., technology, program,

etc.) spreads from any adoption unit to another unit in a given social system (Kee et al.,

2017). For instance, strong ties are fundamental in facilitating faster flow of information

on different social media platforms under specified configurations of the network (Kee et

al., 2016). The diffusion of innovations also includes a fundamental decision process

supported by Rogers’s (1995) innovation diffusion theory (De Almeida et al., 2016).

Additionally, a specific stochastic framework can be used for different innovation

diffusion stages and modeling user adoption, though diffusion can be studied using the

several diffusion models (Mehmood et al., 2016).

Diffusion innovation theory deals with how technology is diffused and utilized to

be able to reach more patients (Lien & Jiang, 2017). To understand how different

individuals translate new concepts or ideas is one use of diffusion innovation theory.

Further, the diffusion innovation theory also promotes the use of high technology media

with high-speed transmission characteristics in order to meet different health needs such

as diabetes (Lien & Jiang, 2017). There are five different stages of the innovation

diffusion process: knowledge, persuasion, decision, implementation, and confirmation

(Zhai et al., 2017). Further, innovation plays an important role in transforming different

research traditions (Zhai et al., 2017). Although innovation remains challenging and time‐

consuming, diffusion of innovations is central to promoting HIT implementation,

bringing necessary progress, and staying competitive in the primary care industry.

Diffusion innovation theory applies to how different forms of innovation are now

becoming the norm in improving health care. Wearable health-monitoring systems for

patients are becoming popular, especially in enabling the noninvasive diagnosis of vital

functions of the human body to assess health conditions (Soh, 2015). Besides typical

singular heartbeat or perspiration sensors, commercially available before 2015, the

deployment of a series of body-worn sensors can enable an effective health-monitoring

mechanism to evaluate the conditions of patients (Soh, 2015). Factors from technology,

health, and privacy perspectives impact the decision of consumers and patients to adopt

health care wearable technology (Gao, 2015). Fitness device users care more about

hedonic motivation, functional congruence, social influence, perceived privacy risk, and

perceived vulnerability (Gao, 2015). Medical device users pay more attention to

perceived expectancy, self-efficacy, effort expectancy, and perceived severity (Gao,

2015). The information obtained from such systems and devices can also either be

relayed directly to any health-monitoring personnel in the case of emergencies or can be

logged and analyzed as a part of preventive health measures and will be able to facilitate

faster medicinal remedies (Soh, 2015). In relation, the decision of patients to finally

accept the application of HIT is because of the ability of health care and HIT providers to

assure patients of efficient health care delivery and that the data of patients are also

secured.

HIT can also be linked to the proper application of technology in the field of

health care to provide the accessible and quality health services to the patients who are in

need, which requires knowledge and skills support for user acceptability. It is important

to address group, individual, and social creativity by making connection to seemingly

unrelated ideas for innovation; however, this can be difficult when making connections

between fields like biology and technology (Kusiak, 2016). But these ideas are

fundamental in redirecting research activities and research development (Alexander et al.,

2016; Bee et al., 2018). Thus, nurses and other health professionals should be equipped

with sufficient knowledge and skills that support HIT.

The use of technological innovation in the field of health care is increasing

(Yaeger, Shoirah, Kellner, Fifi, & Mocco, 2019). Innovation diffusion that operates at the

organizational level is fundamental to technological innovation; innovation diffusion and

technological innovation are interrelated. The innovation diffusion operates in four

stages: (a) knowledge, (b) persuasion, (c) decision, and (d) confirmation (Dearing & Cox

2018; Dearing et al., 2017). Patients should be equipped with knowledge on how the HIT

system works for them to believe in the usefulness and effectiveness of technology in the

health care field. It is important to equip patients with the necessary knowledge in HIT

system functionalities and the effects on patients’ acceptability and usage. For example,

diffusion takes place among individuals in response to understanding or learning different

aspects about an innovation (Perla et al., 2018). Diffusion is a social activation form that

is likely to take place after certain information is disseminated (Perla et al., 2018; Onie et

al., 2018). Thus, information ascertained through HIT should be considered as sensitive

and should not be disseminated without the proper patient consent. Further, patients

receive more access to health care systems and health care professionals enjoy more

options on how to better coordinate and collaborate with their patients.

Strategies for Implementing Health Information Technology in Primary Care

Practice

HIT includes tools necessary for running primary care facilities in the 21st

century. The new applications used in HIT include cloud computing, mobility in health,

e-health, telehealth, and other remote delivery of health care services (Godbole, 2015).

Accountable care organization leaders and managers are learning how to use HIT systems

to provide better care regarding quality and efficiency (Wu, Rundall, Shortell, & Bloom,

2016). HIT adoption is also a reliable and necessary tool to operate a primary care

practice efficiently with financial success (Wu et al., 2016). Further, HIT adoption can

help improve health care services accessibility, accuracy, reliability, and efficiency in the

primary care industry. For example, people and patients experiencing trouble accessing

health care services for reasons unrelated to their insurance statuses are more likely to

look for support using the Internet to obtain health information, including different HIT

features (Amante, 2015). Improving the accuracy and reliability of publicly available

online health information also assists patients who have trouble accessing health care

services (Amante, 2015). Therefore, PCPs need to develop strategies to enable successful

HIT implementation.

To gain the benefits of emerging technologies, it is important to make sure that

the health care system remains (a) accessible to patients, (b) empowering to patients, and

of HIT may translate into benefits for health and well-being by helping people to manage

their own health, support healthy living, and gain access to useful information at any time

and place (Paglialonga, Lugo, & Santoro, 2018). Thus, using applications in health care

has benefits such as patient empowerment, increased patient awareness, and improved

patient–doctor communication.

Widespread use of HIT within the primary care industry can improve the quality

of health care, prevent medical errors, reduce health care costs, increase administrative

efficiencies, decrease paperwork, and expand access to affordable health care. HIT

adoption into a health facility can also result in more than 8% increase in revenue as well

as improving health care quality (Lee & Choi, 2016). Another positive impact of HIT is

the ability of the hospitals to reduce waste and to maximize energy efficiency (Godbole,

2015). Replacing the IT equipment and upgrading with energy efficient systems such as

virtual servers, virtual data storage, and efficient application and database structures can

reduce IT power consumption for the replaced equipment by up to 40% compared to data

center networks without any power saving scheme (Biswas, Ray, Sondur, Pal, & Kant,

2019). Additionally, virtual server and virtual data storage technology are methods that

allow hospitals to reduce equipment and system management costs. Further, costs reduce

when patients are empowered to utilize HIT in managing their health (Godbole, 2015).

Therefore, the use of facilities such as HIT can create a major impact not just for the

patients but also for the health care providers.

Recent advances in the adoption and use of HIT have had a dramatic impact on

the practice of medicine (Payne et al., 2016). However, HIT implementation continues to

be a challenge for some PCPs. Many practitioners and primary care facilities are yet to

adopt HIT despite reported benefits (Lee & Choi, 2016; Payne et al., 2016). To address

this, HIT-related clinical care and public health communication efforts may focus on the

differential benefits accrued with e-Health usage (Kontos, 2014). Addressing the

communication inequalities and persistent disparities in health outcomes has led to

efficient and faster patient results (Kontos, 2014). Public health and medical practitioners

use HIT to communicate with patients in both traditional and novel ways to address

health concerns such as diabetes management, cancer prevention, smoking cessation, and

heart health (Kontos, 2014). Thus, innovative developments, like HIT, indicate the

importance of successful technology implementations to empower the patients and

improve their health.

In 2017, Rittenhouse et al. examined the correlation of HIT implementation

among a national cohort of small primary care practices in the United States. Rittenhouse

et al. looked to ascertain the rate of adoption and use among small PCPs over time.

Studies of individual physicians indicated that primary care physicians, and particularly

family physicians, are more likely than their colleagues to adopt and use HIT (Fragidis &

Chatzoglou, 2018; Rittenhouse et al., 2017). Rittenhouse et al. demonstrated an increase

in 16 measures of HIT adoption and use by a nationally representative cohort of 566

small primary care practices between 2007-2010 and 2012-2013. The proportion of

practices that relied on paper records dropped precipitously during this period, and

functionalities such as e-prescribing, e-mail with patients, and use of an electronic health

record to collect clinical quality data increased substantially (Rittenhouse et al., 2017)

HIT implementation, or adoption into primary care facilities, presented a different set of

challenges to clinicians and management of the facility. For example, Fragidis and

Chatzoglou (2018) found that commitment and involvement of top hierarchy, senior

management, and leaders in the HIT implementation process was the most significant

success factor. However, a lack of support from medical, nursing, and administrative staff

can also cause failure of HIT implementation (Fragidis & Chatzoglou, 2018).

Collectively, Fragidis and Chatzoglou and Rittenhouse et al. discovered how vital

commitment and involvement of senior management, leaders, medical, nursing, and

administrative staff are to the success of HIT implementation. Users and leaders are,

therefore, a more significant part of every successful HIT implementation.

Independent hospitals and small health systems face daunting challenges in

developing their health care IT capabilities to meet the requirements of value-based care.

Some PCPs and small practices in the United States faced financial difficulties in their

attempts to cover the cost of HIT implementation (Zulman, 2015). To provide quality

patient care and remain competitive in the health care industry, requires investments in

HIT (Burgdorfer & Simnick, 2016). Burgdorfer and Simnick (2016) examined how

independent hospitals and small health systems dealt with a lack of funds when adopting

HIT.

Patients often use HIT for multiple health issues to support self-care for certain

conditions that would allow to transcend disease boundaries (Zulman, 2015). Thus, the

availability of mobile devices which support HIT accessibility affects health and

medicine practices profoundly (Ventola, 2014). Further, the rapid integration of mobile

devices and technology into clinical practice will improve the rising availability and

quality of medical software applications (apps; Ventola, 2014). Per Ventola, (2014),

several issues and challenges are present in the future integration of mobile devices and

apps into health care practice. To ensure a fundamental level of quality and safety when

using medical apps and HIT argues the development of rigorous evaluation, assessment,

validation, and best practice standards (Ventola, 2014). With the implementation of

assessment measures, the main determinant of an apps’ value may be provision of

meaningful, accurate, and timely end user information and guidance (Ventola, 2014). The

quality of HIT and apps serves the vital purpose of improving patient outcomes, thus

improving the health care system (Ventola, 2014).

Independent hospitals and small health systems that cannot afford to implement

their own HIT, fall behind competitors (Burgdorfer & Simnick, 2016). In meeting this

challenge, some independent and small health systems elect to collaborate with larger

systems that have the capital and expertise to facilitate an electronic health record rollout.

The increasingly vital role HIT adoption plays in a hospital’s business operations has

been a significant factor (Burgdorfer & Simnick, 2016). There are several models of the

ways that research and other factors can influence policy (Gold, 2009; Peterson 2017).

Well-known models of the policy process begin with problem identification and describe

the pathways by which evidence affects policy formulation. Therefore, PCPs and small

health system leaders must carefully weigh their options and proceed cautiously in

meeting the challenge of sourcing and implementing HIT.

With HIT implementation, PCPs target improvements in patient care through

improved adherence to clinical guidelines, the enhanced monitoring of diseases, a

reduction in medical and medication errors, and access to more accurate and complete

health information. However, Doekar and Sarnikar (2016) noted that the implementation

of HIT did not guarantee improvements. The adoption of HIT is a process of

implementing change in an organization. Changes within an organization are usually

associated with employee psychological uncertainty about how the change will affect

their lives (Nilsen, Schildmeijer, Ericsson, Seeing, & Birken, 2019). Therefore, HIT

adoption being new or replacing an existing one, creates change in the organization, the

work process, and employee’s attitudes. Implementation can be daunting with unforeseen

circumstances as HIT involves more than just the application of technology. Deokar and

Sarnikar (2016) posited that the success of electronic health record implementation is

dependent upon change management; electronic health record implementations require

complex changes to core organizational processes. Understanding health care

professionals’ change responses may be critical for facilitating implementation to achieve

an evidence-based practice in the rapidly changing health care environment (Nilsen et al.,

2019).

The Classification of Health Information Technology

To transform into a value-based health care delivery model, leaders of the

American health care delivery system focus on improving clinical quality, safety, and

outcomes at the lowest and most reasonable cost possible to the consumer (Harris et al.,

2017). Presently, PCPs seek new sources of competitive advantage and cost-cutting

measures wherever possible. Since the passage of the Patient Protection and Affordable

Care Act in 2010, health systems, hospitals, and medical groups have faced considerable

public pressure to assume an increased amount of risk for the costs and outcomes of their

patient population through value-based payment models (Kerrissey, Satterstrom, Leydon,

Schiff, & Singer, 2017). Successful HIT implementations facilitate leaders may better

manage patient care through the secure use and sharing of patient information. When

PCPs implement HIT, it can improve the quality of care and make it more cost-effective

through the adoption of HIT, which makes patient information available electronically

when and where needed. It is imperative for PCPs to investigate modern technology and

identify areas in which HIT can help improve the quality of service for efficient patient

care.

In the 21st century, health care leaders can use HIT to plan, organize, monitor,

and control their businesses, regardless of their health care industry (Couchoro, 2016).

HIT helps support information management and secure data to enhance patient

information storage and retrieval for efficient patient care and profit maximization.

Carvalho, Rocha, Vasconcelos, and Abreu (2019) posited that the increasing volume of

data, is exceeded the ability of health organizations to process it for improving clinical

and financial efficiencies and quality of care. Therefore, data management and analytics

is critical in primary care practice. Data management includes processes and technologies

to acquire, store, prepare and retrieve data for analysis. HIT as five applications popularly

used in most primary care settings:

1. Electronic health record (HER)

2. E-prescribing

3. Telehealth

4. Clinician decision support

5. Secure messaging

Dorsey (2016) found that the evolving digital revolution shifted telehealth

delivery from clinics to the home. Primary care practitioners leverage HIT to improve

health care delivery and make health care more accessible (Dorsey, 2016). In an

integrated care model involving primary care providers (PCPs) and obesity specialists,

telehealth may be useful for overcoming barriers to treating childhood obesity because

childhood obesity may be addressed without having the child or patient physically visit

the clinic or the hospitals (Fleischman, 2016). However, the rapid growth of telehealth for

health care delivery exposed the lack of training available to prepare all levels of

clinicians for this modality of using technology to make health care more accessible

(Papanagnou, 2015). Issues range from care coordination to legal and ethical implications

to new ways of engaging patients which must be addressed to better understand and apply

HIT (Papanagnou, 2015).

Villasenor (2017) noted that providers of health care with fewer years in medical

practice seem to have knowledge of e-prescribing because they have access to more

updated innovation system and technology. Further, Vilasenor determined that

knowledge of e-prescribing corelated with health care providers using HIT to deal with

their patients. Patient education and exposure to e-prescribing has the potential to

decrease perceived barriers and increase perceived usefulness for acute care providers

(Villasenor). Accurate knowledge databases are needed to produce relevant drug

formulary alerts and encourage formulary adherence (Tolley, Slight, Husband, Watson, &

Bates, 2018). The research works of Villasenor and Tolley et al. are imperative in

highlighting the benefits of e-prescription. However, medication-related clinical decision

support is still relatively immature in some organizations and has substantial room for

improvement.

Zadehh (2016) identified four key benefits of using HIT for e-prescribing,

including (a) improving the quality of health care services, (b) increasing the efficiency

and effectiveness when prescribing and dispensing medications for the patients who are

in need, (c) reducing medication errors, and (d) increased health care cost savings. Failure

to properly implement e-prescribing systems in the clinics can, however, also result in

new types of errors that reduce workflow efficiency, increase medication cost, and

threaten patient safety (Zadeh, 2016). Finally, software redesigns to improve HIT may be

needed to remove barriers associated with uncertain pharmacy hours which can be

inefficient for the patients, controlled substance prescribing, transmittal confirmation, and

bidirectional communication needs of the patients, thereby improving motivation to e-

prescribe (Villasenor, 2017).

Advantages of Health Information Technology

HIT implementation in the primary care industry has the potential to improve the

health of individuals and the performance of practitioners, yield improved quality, reduce

costs and paper waste while providing easy access to patient’s medical records and

greater engagement by patients in their health care. Management systems allow for the

acquisition, storage, transmission, and display of administrative or clinical activities

related to patients, such as electronic health records or electronic medical records

(Rouleau et al., 2017). Fernandez-Planelles, Jover, Palomar, and Calvo (2016)

investigated the organization of health service systems as a part of their effort to achieve

better preventive control and management of chronic disease treatment. To support the

proper care continuity, Fernandez-Planelles et al., determined that HIT implementation

was a fundamental tool which supported comprehensive care, improvement of drug

treatment, and better prevention control through effective communication.

To properly administer treatment in the health care industry, the implementation

of HIT helped to streamline the care process communication among clinical specialists.

Communication also creates an atmosphere to promote engagement of professionals in

the various evolutionary stages of a disease, improve the clinical approach, reduce the

clinical variability, promote the continuity of care, reduce morbidity, and standardize

registration processes to improve perceived quality and patient satisfaction (Fernandez-

Planelles et al., 2016). Significant increases in IT spending in recent years has generated

great interest in its effects on the health care industry cost structure, health-care quality

and patient privacy (Haried, Claybaugh, & Dai, 2017). Concerning HIT advantages,

Fernandez-Planelles et al. and Haried et al. conveyed that HIT implementation has

necessitated, and enhanced, the interaction among patients, physicians and other care

professionals without the barriers of time and distance.

Jassas (2015) studied the advantages of e-health smart network system. The

architecture for this system includes medical sensors which can help the patients by

measuring their physical parameters by using wireless sensor networks (WSNs). These

sensors transfer data from patients’ bodies over the wireless network to the cloud

environment which is a form of HIT. Rahmani et al. (2018) also noted that because of the

ubiquitous computing nature of IoT, all the health care system entities (individuals,

appliances, medicine) can be monitored and managed continuously. By applying IoT

technologies to health care, the quality and cost of medical care can be improved by

automating tasks previously performed by humans Therefore, patients will have a high-

quality service as the e-heath smart system supports medical staff by providing real-time

data gathering of their medical data. The WSNs eliminates manual data collection, and

enables the monitoring of huge numbers of patients, and removing the possibility of

human error (Jassas, 2015).

Sheikh (2015) determined that perceptions of HIT included improved patient care,

improved population health, and a reduction of health care expenditures for the patients

and for the institutions running hospitals. Sheikh believed that HIT catalyzed the creation

of a publicly accessible digital infrastructure and that users determined innovative ways

to improve quality of care and realize cost efficiencies. Early experiences indicated that

the resulting digital infrastructure in the field of health care enhanced the quality of care

and curtail costs (Sheikh, 2015). Reform efforts in health care systems are severely

limited by problems with usability across ages, limited interoperability, and the

persistence of the fee-for-service paradigm. The ratio of aging population has risen

significantly since 2012 meanwhile the progressive decline in physical and cognitive

skills prevents elderly people from living independently and from performing basic

instrumental activities of daily living (Mshali, Lemlouma, & Magoni, 2018). Addressing

these issues needs to be the federal government’s main policy target to ensure a wider

coverage in terms of patients who can actually access HIT features (Sheikh, 2015).

In today’s modern technological world, the best and most efficient ways to

improve the quality and effectiveness of health care services is through HIT

implementation. Sun and Qu (2015) concluded that understanding the factors that have

significant effects on HIT adoption may assist practitioners and policy makers in

developing effective solutions to the HIT implementation process, making it smoother

and seamless for physicians, patients, and other health care professionals. Primary care

leaders can improve the quality of patient care by providing accurate, timely, reliable, and

secure data to users. Primary care physicians who implement HIT can help improve the

quality of patient care significantly. The quality of patient care in hospitals can improve

significantly after HIT implementation (Khatri & Gupta, 2016). However, to ensure

quality health care as a result of HIT implementation, training and coaching should also

be a priority to equip the patients and the health professionals with the knowledge and

educated on how to make the HIT system work.

HIT implementation in the primary health care industry has the potential to

improve patient safety and health but its implementation and use has led to unintended

consequences and new safety concerns (Singh, 2015). A key challenge when improving

safety in health IT-enabled health care systems in hospitals and clinics is to develop

valid, feasible strategies to measure safety concerns at the intersection of health IT and

patient safety. Graber, Siegal, Riah, Johnston, and Kenyon (2019) also noted how the

adverse events associated with HIT vulnerabilities can cause extensive harm and are

encountered across the continuum of health care settings and sociotechnical factors. The

HIT framework should be able to facilitate organizational learning and involvement of

the HIT vendors in the health needs of the patients who use their HIT applications (Singh,

2015). HIT vendors should consider that not all users of HIT are already adept with the

know-how on how to properly use technological gadgets required to effectively use the

HIT system.

Medical error and improper treatment, as a result of wrong patient information,

tends to be a major concern in the health care industry, which can worsen a patient’s

condition, potentially resulting in premature death. Risks to patient safety occur

throughout health care settings by failure to correctly identify patients, resulting in the

incorrect patient, incorrect site procedure, incorrect medication, and other errors (Jeon et

al., 2019). The implementation of HIT and barcode technology can prevent medical

errors by providing detailed and reliable information for patient care. Barcode is one of

the most powerful and economical methods of improving the patient safety and reducing

cost (Hachesu, Zyaei, Leila, & Hassankhani, 2016). The readiness of the health

professionals and the patients should always be considered when starting to implement

HIT system. However, effective and successful implementation of barcode technology

depends on the various issues including financial planning and organizational readiness.

According to Hachesu et al. (2016), the most critical steps for the successful

implementation of barcoding in health care organizations largely depends upon the

readiness of managers to accept and apply the policies of barcode technology, allocation

of priorities, and monitoring applications.

The U.S. Department of Health and Human Services officials conducted a study

to examine the relationship that exists between HIT and health outcomes, costs, and

administrative efficiencies. The findings made by different studies demonstrated a

positive relationship between HIT use and health outcomes (U.S. Department of Health

and Human Services, 2016). Feinberg et al. (2016) determined that 50% of the health

care funds get wasted because of inefficient processes, yet implementation of HIT have

measurable financial benefits. Henry et al. (2016) noted that 75% of laboratory

technicians reported that use of electronic medical health records helped them to get lab

results faster using a conventional method. The research works of Feinberg et al. and

Henry et al. are significant in highlighting the profit potential and cost savings as a result

of HIT implementation.

According to Gesulga et al. (2017), HIT implementation enables error-free and

high-quality care in effective and efficient ways. In addition, HIT helps in making the

access to crucial information needed by professionals in remote areas easy (Garofalo et

al., 2015). HIT implementation is also essential to ensuring clear and complete

documentation of patient’s health records. The implementation of HIT in primary care

facilities makes the challenge of deciphering someone else’s handwriting outdated.

Primary care practitioners enter their orders directly into computer systems, potentially

eliminating transcription errors and dramatically improving turnaround time. For

example, when a practitioner enters a prescription order, the system automatically checks

for any adverse drug interactions or allergies and immediately alerts the physician if any

are found. Another benefit of successful HIT implementation in the primary care industry

included the easier and faster tracking of drug interactions warnings (Institute for Safe

Medication Practices, 2017). Garofalo et al. (2015) and Gesulga et al. (2017) collectively

confirmed the potential improvement and value HIT implementation can add to health

care services.

Implementation Failure of Health Information Technology

Over a short time, some PCPs have realized they can daily depend upon HIT for

operational benefits. Interest in HIT adoption continues to grow significantly among

practitioners and other care providers due to its possible positive impact on health care

(Gesulga et al., 2017). The implications and importance of HIT result in rapid growth,

thereby, creating fierce competition in the primary care industry (Garofalo et al., 2015).

Although HIT implementation contributes significantly to the performance and growth of

other health care organizations, HIT implementation alone does not guarantee an

improved organization’s performance, profitability, or a competitive advantage in the

health care industry (Yusif, Hafeez-Baig, & Soar, 2017).

Fischer (2014) conducted a seminal study regarding the barriers inherent in HIT

uptake by patients. For example, elders face many barriers in using technology for health

care decision-making, including (a) issues with familiarity with the use of technology, (b)

willingness to ask for help, (c) trust of the technology, (d) reduced privacy, and (e)

intuitive user design continue to challenge implementation success (Fischer, 2014). The

barriers identified by Fischer must be addressed for HIT tools to be available to the

growing population of patients who belong to different generations. Design, education,

research, and policy all play roles in addressing these barriers to acceptance and use

(Fragidis & Chatzoglou, 2018). Fischer noted that elderly people approach the Internet

and HIT differently than their younger counterparts but have growing rates of adoption.

Assistive technology in the field of health care, such as sensors or home monitors, may

help aging in place but not yet evaluated because of lack of sufficient support to the usage

of HIT (Fischer, 2014). As a form of assistive technology, it must be noted that HIT

should not substitute for the real health care attention from doctors and health care

professionals when ultimately necessary. Therefore, successful implementations of HIT

should also include patient promotion and provide a user-friendly information system that

assists user adoption (Soh, 2017).

HIT implementation failure negatively affects primary care facilities. Yusif et al.

(2017) found that a lack of readiness assessment factors, including core readiness,

engagement and buy-ins readiness, technological readiness, and IT skills readiness were

the major cause of failures. HIT implementation readiness refers to the preparedness of

PCPs and their technical team for the anticipated change brought by programs related to

HIT. Therefore, conducting readiness assessments prior to HIT implementation can help

reduce HIT implementation project failure while increasing the success rate. However, it

is essential to understand the determinants of readiness for HIT adoption. After

determining readiness, the effectiveness of the implementation process is as important as

the quality of the system implemented (Fragidis & Chatzoglou, 2018). Therefore, before

implementing HIT applications or before using HIT applications, health professionals

should be equipped with sufficient knowledge and skills on how to better implement HIT.

Fragidis and Chatzoglou, and Yusif et al.’s studies remain useful in identifying HIT pre-

implementation and post-implementation preparedness for sustainable HIT adoption.

Prior to a HIT implementation, organizational leaders should evaluate the fit

between employee computer skills and the proposed electronic health record system

(Fragidis & Chatzoglou, 2018). Having employees who lack computer skills, and who

dislike or are disinterested in adopting computer usage, will negatively affect HIT

implementation (Yusif et al., 2017). Furthermore, the quality of the design of the system

graphical user interface, the functionality of the features incorporated project

management, procurement, and user previous experience also affect the implementation

of HIT (Birken, 2019). However, lack of efficient implementation team, insufficient

support by management, and inadequate startup planning can lead to HIT implementation

failure (Birken, 2019).

In a study conducted by Mettler (2016), to explore varying HIT implementation

consequences and expectations, the author investigated factors affecting the viability and

fit of HIT. Mettler found that different stakeholders perceive HIT viability and fit of the

same HIT services while analysis demonstrates that there can be a discrepancy between

the organizational viability and individual fit of a HIT. Mettler noted that managing

expectations throughout the HIT implementation process is a key determinant in avoiding

HIT implementation failure. Ratwani, Reider, and Singh (2019) discovered many existing

HIT products built on technical frameworks that limit the scope and frequency of design

improvements necessary to improve usability. However, successful HIT implementation

is not possible without genuine engagement from all stakeholders, particularly vendors

who should consider greater transparency of their products (Ratwani et al., 2019).

In spite of the positive effects of HIT in primary care practice, HIT

implementation barriers tend to create negative impressions for prospective practitioners.

One obstacle that affects the implementation of HIT is poor infrastructure, where there

are insufficient resources needed for implementing HIT and meeting the demands of the

increasing population (Ivarsson, Wiinberg, & Svensson, 2016). The lack of required

infrastructure, or equipment such as computer software, hardware, wireless

communication channels, and skilled professionals, have made some HIT

implementations difficult. Some of the resources needed such as hardware and software

are costly and besides, lack of qualified personnel to supervise adequately the

implementation process (Fragidis &Chatzoglou, 2018). The authors confirmed through

their research how necessary available resources and personnel are to the success of HIT

implementation. Therefore, though practitioners HIT adoption has the potential to

improve health care services, lack of necessary resources and staff can harm HIT

implementation.

According to Couchoro (2016), the major problems for the implementation of

HIT are time and financial constraints. The complex nature of transformation and

implementation of HIT makes it challenging to complete in a short period (Klersy et al.,

2016; Martin et al., 2016). One of the major barriers in the implementation of HIT is that

patients would most often prefer to be able to talk to their doctors than actually use

gadgets and machines to deal with their health concerns and issues. Other barriers, such

as cost and a lack of skilled personnel, prolong the process of HIT implementation and

increase failure rate. Government health and technology policies that are not in support of

HIT make transformation and implementation difficult. Government and administrators

of a country are critical partners in ensuring successful implementation of health projects.

Government support for HIT research is needed both financially and legally to

successfully implement working plans (Kaufman, Kannampallil, & Patel, 2015). The

health needs of the patients, relating to the transformation of a system, could improve

through an effective, secure, and efficient national policy (Whitt et al., 2017). These

studies are useful in indicating the possible challenges, barriers, and problems in HIT

implementation to help plan effectively to avoid such occurrences.

In addition, there are also cultural and social barriers that affect the successful

HIT implementation in the health care industry. E-readiness and the digital divide are the

major cultural and social barriers in the implementation of HIT which include less

motivation, anxiety to use and adopt a new technology (Barrett et al., 2016; Lippman et

al., 2016). Thus, private practice practitioners should be aware that social and cultural

barriers also affect HIT implementation (Barrett et al., 2016). Further, Lippman et al

(2016) determined that culture and social norm differences can foster the wrong

impression making it difficult for health technology officers to convince leaders to adopt

and implement a HIT (Yen, McAlearney, Sieck, Hefner, & Huerta, 2017).

The Future of Health Information Technology

Leaders view implementation of HIT as just another technology project which is

very promising in the technological advancements in health care. Since 2009, various

investments have been made in health care sectors around the world to implement health

information to improve health care delivery (Bruns et al., 2018; Itrat et al., 2016). The

product types included under the umbrella of HIT are diverse and include telemonitoring

tools, mobile health technology, electronic health records, sensor technologies, and other

medical devices (Bruns et al, 2018). According to Cresswell and Sheik (2016), the use of

HIT products gradually affects almost every health care setting worldwide. Health care

workers are reporting instances of psychological stress induced by health care

information technology (IT) because of lack of sufficient skills in dealing with

technology and related gadgets (Califf, 2015). Several researchers have established a

valuable research program by which to study psychological technostress in health care

workers (Cresswell & Sheik, 2016). Meanwhile, none confirms that IT bears, noting that

technostress associates with negative perceptions and harmful effects of technology in its

efficient implementation in the health care industry (Califf, 2015).

With the development of e-commerce, a growing number of people and patients

prefer to purchase medicine online for the sake of convenience and to avoid having to

physically buy the medicine from the pharmacy (Zhang, 2015). However, it is a serious

issue to purchase medicine blindly without necessary guidance and this forms part of the

barriers that have to be addressed to have an effective HIT (Zhang, 2015). Health care

practitioners HIT implementation and use has become a necessary strategy because of the

immense benefit derived from HIT implementation. The expected benefits, future

challenges, and the rapid growth of HIT, will directly affect the decisions of

policymakers (Colicchio et al., 2016). According to researchers, HIT implementation in

the primary care industry is likely to reduce medical errors, incorrect prescriptions, and

improve performance (Bardach et al., 2017; Chase et al., 2017; Francis et al., 2017).

Furthermore, the implementation of HIT by PCPs sets the pace for better- and high-

quality services in health care and increases profit through waste reduction (Neufeld,

Doarn, & Aly, 2016). The proper implementation of HIT can make high quality services

in health care more accessible for patients. Patients are also more equipped with choices

on how to properly manage their own health. These studies are useful in identifying the

benefits of HIT implementation to practitioners, patients and other stakeholders in the

health care industry.

Health Information Technology and the Cloud

HIT adoption continues to grow at a fast pace with consistent changes aimed at

improving health care, waste reduction, and profit maximization (Narayanan &

Cherukuri, 2018). The health care industry is under constant pressure to streamline the

sharing and availability of information while maintaining rigorous controls over patient

privacy and at the same time, reducing costs (Narayanan & Cherukuri, 2018). HIT plays

a significant role when considering health care delivery by supporting the care of patients

for better health care with advantages regarding cost-effectiveness. Cloud computing

technology is an important milestone and development in medical informatics (Hsieh,

2015). Therefore, within the primary care industry, cloud-assisted HIT implementation

tends to scale data up and down in real-time, which leads to an efficient way of using data

resources (Narayanan & Cherukuri, 2018).

The use of cloud computing technology allows both the patients and health

professionals to have real-time access to the health records without having to meet in

person (Sumathi & Poongodi, 2016). Despite its potential, there are gaps and barriers to

understanding how users evaluate change in relation to the health cloud and how they

decide to resist it (Hsieh, 2015). The resistance by the health professionals in hospitals

and clinics to the use of the health cloud is the result of regret avoidance, inertia,

perceived value, switching costs, and perceived threat(s) (Hsieh, 2015). However,

attitude, subjective norm of the patients and health professionals, and perceived behavior

control have positive and direct effects on health care professionals’ intention to use the

health cloud (Hsieh, 2015).

The World Health Organization (2015) (as cited in Narayanan & Cherukuri,

2018) estimated that thirty-six million (out of fifty-seven million) global deaths were

because of non-transmissible diseases such as stroke, heart disease, cancer, chronic

respiratory diseases, and diabetes. The cloud will aid medical professionals’ accessibility

to patients’ medical records by enabling them to decide on a treatment plan to save

patients in emergencies (Hanen, 2016). It is challenging for care providers to decide upon

on the treatment plan, if accurate, legible, and updated medical records for patients are

not readily available, (Narayanan & Cherukuri, 2018). As cited in Narayanan and

Cherukuri (2018), the results of the World Health Organization report noted that patients

are able to better plan for their treatment schedules because of the presence of HIT

facilities and applications. In relation to the study, what is needed is not just a new set of

integration technology approaches, but also a fundamental change in the way health care

information systems and processes to handle integration requirements.

A new technology for mobile web services, mobile cloud computing, can be used

in the field of health care (Hanen, 2016). Accordingly, Hanen (2016) assumed that

mobile cloud computing is likely to be of the heart of health care transformation because

the patients are now better empowered. In fact, mobile cloud computing offers new kinds

of services and facilities for patients and caregivers. In this regard, a new mobile medical

web service system can help patients and health professionals with fast dissemination of

information and service provision (Hanen, 2016). Many health care managers continue to

move services into the cloud environment (Hsieh, 2015). It is better to store data in this

own format, when compared to Big data (Narayanan et al., 2018).

The proper collection, management, and utilization of health information plays a

critical role in detecting medically-based innovative solutions and allocating resources to

treat patients (Yang et al., 2015). Noted by Hanen (2016), information technologies are

widely employed to improve the quality of health care services. In a study by Yang et al.

(2015), the researchers examined emerging state-of-the-art information technologies for

enhanced health care and provided insight on how the developments in IT can influence

health care practices. Emerging health information technologies such as electronic health

records adoption have the potential to enhance health care abilities, boost preventive care,

and foster collaborative health care (Yang et al., 2015).Thus, Hanen and Yang et al.

determined that preventive health care can be better managed if patients have access to

HIT technology because of their ability to know more information about their personal

health.

Trends in health care, big data analysis, and cloud computing in health care, all

show exciting new developments (Hanen, 2016; Yang et al., 2015). The safe

interoperability of HIT, and other features of IT in health care, minimally require system

components that aligned about a conceptual model (Robkin, 2015). HIT devices can be

assured to be safely interoperable cross-manufacturer only if different manufacturers

share the conceptual model embodied by the communicating devices (Robkin, 2015).

Insights from Hanen (2016), Robkin (2015), and Yang et al. (2015) underscore the

important of PCPs to understand the strategies to successfully implement HIT.

Health Information Technology and Fraud

Health care leaders who adopt the latest electronic health record technology may

realize benefits in the efficiency and quality of health care. The introduction of specific

HIT, such as the electronic health records, helps to reduce delay, fraud, and unnecessary

errors made by health care professionals. Health care fraud is a serious problem affecting

every patient and consumer (McGee, Sandridge, Treadway, Vance, & Coustasse, 2018).

The potential failure of the HIT system is not only in the excessive financial losses

incurred, which extend into the billions of dollars every year but also inpatient harm.

Islam (2015) investigated the impact of modern health technology and the Internet in

health care by interviewing key health care professionals, elected representatives, and

local informants. McGee et al. and Islam’s study findings indicated that modern health

technology, the Internet, and electronic devices for recording health data, enhanced health

care delivery. The authors’ findings are significant as it showed that health information

and communication technology is an effective mechanism for reducing corruption and

promoting transparency.

The introduction of HIT in primary care facilities can lead to unintended

consequences which must be strictly monitored to ensure that there will be no detrimental

impact for the patients (Melby, 2014). Communicating via e-messaging, utilized in the

health care system, can lead to less face-to-face contact between homecare nurses and

general practitioners. Even though e-messaging means that there is an opportunity to

communicate more efficiently, both groups emphasized the need for sustaining

interpersonal relations via face-to-face communication to collaborate efficiently (Melby,

2014). For example, nurses who use HIT in dealing and interacting with their patients

experienced e-messages as a more powerful means of communication to their patients

vis-à-vis general practitioners than other means of communication, thus making e-

messaging a tool for empowering them in their collaboration with general practitioners

(Melby, 2014). Nurses said that the fact that e-messages were automatically documented

in the patient’s electronic patient record system gave more weight to their requests. On

the centrally, Oppezzo et al. (2018) stated that e-message intervention did not improve

treatment adherence, future studies can learn from this pilot and may incorporate more

variety in the prompts and more interaction to promote more effective user engagement.

Unintended consequences of HIT affect collaboration between health care

workers and therefore, the unintended consequences of HIT should be properly observed

in order to prevent them from happening (Melby, 2014). The consequences may be both

desirable and undesirable, with previous research primarily focusing on the undesirable

unintended consequences. Melby (2014) noted that this can affect both the patients and

the health care providers. The introduction of e-messaging has led to both desirable and

undesirable unintended consequences for interprofessional collaboration because of the

less interaction between the patients and the health professionals (Melby, 2014).

Consequently, post HIT implementation tasks and responsibilities were sometimes

reconfigured in unexpected ways (Melby, 2014). Islam (2015) advocated that managers

who control task reconfiguration will more reliably achieve successful HIT

implementation. Islam and Melby’s studies are essential because more insight into

positive unintended consequences accrued to the implementation of HIT could be a

resource for planning work reorganization. Further, reconfigured tasks and

responsibilities must be accomplished to ensure that the desired benefits of employing

HIT in the health care system achieved.

Fraudsters commit a wide variety of schemes against private and public insurance

companies by filing fictitious health care claims to generate profits (McGee et al., 2018).

For example, Boris Sachakov, the indicted owner and operator of Colon and Rectal Care

of New York, used HIT to aid fraud (Association of Certified Fraud Examiners, 2018).

Sachakov’s indictment papers noted submission of more than $22.6 million in false and

fraudulent claims to Medicare and private insurance companies for surgeries and medical

services that were never provided, Sachakov received more than $9 million on those

claims (Association of Certified Fraud Examiners, 2018). Sachakov illegally collected

those funds because of open technology accessibility, downplaying the record trace by

HIT (Association of Certified Fraud Examiners, 2018). Subsequently, to combat all

categories of insurance fraud, the Obama administration created the Health care Fraud

Prevention Partnership to detect waste, fraud, and abuse (McGee et al., 2018). McGee et

al. (2018) determined that over the seven years of the Obama administration, the U.S.

government worked more efficiently to combat Medicare waste, fraud, and abuse through

HIT use, education, and research. Therefore, as further innovation is still expected in the

field of HIT in order to create a more accessible health care system and to minimize the

barriers to the successful implementation of HIT, more study is justified.

The e-HIT scores of most nurses and health professionals indicated that the

communities had underestimated the amount of work involved in implementing at scale

for the HIT technology in the health care system (Devlin, 2015). The new knowledge

being generated through the different HIT programs may contribute to the ongoing

transformation of digitally enabled health care system (Yeow, 2015). Thus, Devlin (2015)

expects more personalized flexible models of provision, which resonates with the current

e-health policy environment. The effects of telemedicine, as a feature of HIT on the input

allocative efficiency of the health care process through the reallocation of organizational

resources, was evaluated. Yeow (2015) assessed whether gains in allocative efficiency

resulted in improvements in organizational outcomes in organizations that use HIT, such

as lower hospitalization rates and lower uncertainty in patient wait time. Applying the

theory of swift and even flow, Delvin and Yeow suggested that the gains in allocative

efficiency for some processes are associated with improved organizational outcomes and

therefore, the use of HIT and telemedicine should be supported.

Summary

Kelly (2016) determined that the adoption of HIT in hospitals and health care

increased operating costs but also provided certain benefits to the health care.

Furthermore, health professionals and patients are empowered to use HIT to monitor their

health (Dranove, 2014). HIT is a technology project, which is very promising in terms of

the technological advancements in health care. Evidence-based medicine is devoted to

developing the science and technology of clinical epidemiology and improving the

technical means of applying its principles and tools consistently and efficiently to help

and benefit the patients (Kelly, 2016). The research question in this study was, “What

successful strategies do PCPs use to implement HIT to improve primary facility care

delivery and profitability?” The relevant studies about HIT, and how it is implemented by

health care professionals, were discussed in the literature review of this study. This

chapter also included a discussion on the challenges and barriers. To better understand

the concepts in literature, the theoretical frameworks were applied. To have a well-

founded data analysis, the review of literature serves as a basis for the next section.

Transition

Section 1 entailed the background of the study and included the problem and

purpose statements. I further articulated the central research question and interview

questions before an in-depth description of the nature of the study. This chapter also

included a discussion on HIT implementation prospects, challenges, and barriers. The

theoretical frameworks were applied to understand the concepts in literature better. The

review of literature will serve as a guide in the next chapters to have a well-founded data

analysis of the data in this study. Section 2 addresses the purpose statement, role of the

researcher, participants, research method and design, population and sampling, ethical

research, data collection instrument, technique, and analysis, reliability, and validity of

the study, and provides an overview of Section 3.

Section 2: The Project

The purpose of this study was to explore successful strategies PCPs used to

implement HIT to improve primary facility care delivery and profitability. The specific

business problem is some PCPs lack successful strategies to implement HIT to improve

health care delivery and facility profitability. The research question for this study was

“What strategies do PCPs use to successfully implement HIT to improve health care

delivery and profitability?” To answer this question, I interviewed PCPs who successfully

implemented HIT to improve health care delivery as the source of data (e.g.,

participants). Additionally, qualitative methodology with a multiple case study design

was used to address the research question.

Section 2 includes the different aspects of the chosen methodology. The

discussion is aligned with a qualitative multiple case study. Therefore, the 10 topics are

(a) restatement of purpose statement; (b) role of the researcher; (c) participants; (d)

research method and design; (e) population and sampling; (f) ethical research; (g) data

collection instruments; (h) data collection technique; (i) data analysis; and (j) reliability

and validity.

Purpose Statement

The purpose of this qualitative multiple case study was to explore successful

strategies PCPs use to implement HIT to improve primary facility care delivery and

profitability. The target population comprised PCPs from six primary care facilities

successfully using HIT for daily health care delivery in Queens County, New York. For