Knowledge that Transforms

This study investigates the role of health information technology (HIT) in reducing claim denials, which are a significant burden for healthcare providers in the U.S. We theorize the impacts of electronic health records (EHRs) on claim denials, starting with an examination of EHR adoption and followed by a deeper assessment of how EHRs are sourced both within a hospital and across hospitals in the same health system. We propose that while EHR adoption reduces the likelihood of claim denials by improving the accuracy and completeness of information processing, it can also increase claim denials if EHR applications are sourced from multiple vendors within a hospital or different vendors across hospitals. Using a large-scale dataset of claim records from the state of Maryland from 2012-2016, we found that the greater the EHR adoption by care providers, the less likely a claim is denied. In addition, our findings suggest that EHRs are more effective in preventing denials when a hospital sources EHR applications from a single vendor and when a group of hospitals in the same health system sources EHRs from the same vendor. Additionally, we observed a decrease in claim denials when physicians previously worked in hospitals utilizing EHR applications from the same vendor. This study provides significant theoretical insights into the information systems literature on HIT and offers practical implications for healthcare providers by uncovering the multifaceted roles of EHRs in information processing and compliance.

Ex nihilo nihil fit—nothing comes from nothing—fundamentally challenges IS scholars to explain how a new behavior may emerge and evolve into a recognizable practice from an organization’s IT implementation processes. Prior research addressing this problem has ascribed consequences to a preexisting macrolevel structure or microlevel interactions. We examined this issue by conceptualizing the emergence of IT implementation consequences as a multiphased process with analytically disaggregated phases. Using an assemblage lens, our theorizing draws on data from a multisite case study of body-worn camera technology implementation in three municipal police organizations in the U.S. We identified three emergence phases—individuation, composition, and actualization—and developed a process model theorizing a path from material and expressive components to IT implementation consequences through cascading properties and capacities. Our model shows that the emergence of IT implementation consequences is nonlinear and involves feedback loops across multiple phases. In some instances, IT implementation consequences may emerge via negative feedback loops involving tweaks and course correction before converging into recognizable new practices. In other instances, they may fail or convergence into recognizable practices may be delayed. We also show how combining existing components and assemblages results in nesting assemblages at successively larger scales. This allowed us to relativize the micro-macro relationship and explain both top-down and bottom-up emergence of IT implementation consequences.

Prior research suggests that high prices may motivate the decision to pirate entertainment goods. We analyzed a natural experiment that decreased the tax rate, and hence also the net prices of e-books, by 14% in Ireland while several other European countries were not affected. Using country-specific data on piracy visits, we found that this price decrease caused only a small and statistically insignificant decrease in total e-book piracy visits. However, we further decomposed piracy visits into those of direct pirates, who navigated directly to piracy sites, and indirect pirates, who searched to find piracy sites. The 14% price decrease caused no change in direct piracy visits but caused a statistically significant 27% decrease in indirect piracy visits. These findings align with prior research suggesting that search can play an important role in piracy, but only for some pirates. Our results demonstrate the potential of using price to mitigate piracy, but they also highlight the challenges firms face in competing with piracy for experienced pirates. We conclude by detailing both the policy and managerial implications of our work.

Software firms are increasingly adopting an open source strategy, allowing them to leverage the effort exerted by the open source community toward improving software quality. In addition to embracing a proprietary or fully open source strategy, several firms choose a partial openness strategy wherein only certain parts of the code are open source while the rest is proprietary. Specifically, when adopting a partial openness strategy, a firm may choose to make the core software code open source while keeping the extension software code proprietary or keep the core proprietary and make the extension open source. When making decisions related to different openness strategies, firms need to take into account the level of effort they are exerting toward the improvement of the quality of software, the level of engagement of the open source community, and pricing. Hence, the decisions related to a firm’s openness strategy are not straightforward. While this is an important question for many firms, it has not been analyzed in the literature. In this research, we attempt to fill this important gap by analyzing different openness strategies in the context of resource allocation for fixing defects. Specifically, using a game-theoretic model, we explore when a firm should make its software fully open source or partially open source and when it should keep it proprietary. Our results show that when the baseline demand for the firm increases with the extent of openness, the firm should either make its software fully open or keep it proprietary and, importantly, should not rely on partial openness. Next, in scenarios where customers are highly sensitive to security risks, the demand loss to efficiency gain ratio has an important role in determining a firm’s optimal openness strategies. These findings provide important insights to firms on how to effectively plan their openness strategies and also establish a basis for future research on the topic of partial openness.

Many countries are developing health information infrastructures (HII) such as integrated electronic health records (EHRs) as a means of improving healthcare efficiency and effectiveness. However, efforts to build and scale up HII are fraught with challenges, as exemplified by the well-known case of the National Health Service (NHS) in England. In particular, HII scaling initiatives give rise to tensions, such as across geographical boundaries of EHRs, which are often not effectively addressed in practice. At the same time, there have been calls for research on scaling IS through a practice perspective, which adds to the existing categorical analysis of scale. Thus motivated, we aim to conceptualize the scaling of HII, focusing on the tensions between scales, the practices to accomplish scaling, and their consequences for scaling outcomes. To do so, we undertook a case study of recent NHS efforts to integrate EHRs in England, where we analyzed these scalar concepts and their interrelationships. Our study further develops the notion that scaling not only involves increasing the scale of IS but entails constructing and reconstructing scales. We also offer theoretical contributions by conceptualizing the range of scalar tensions and practices, their interplay, and their influences on HII scaling outcomes. Tensions that we identify as associated with different scale boundaries (organizational, spatial, and technological), extend those recognized in prior research. Furthermore, we uncover the scalar practices of joining and differentiating, adding to the governance and architectural approaches for HII scaling examined in past work. Through deepening the understanding of HII scaling, we generate insights for practitioners by highlighting scalar tensions and practices that could address the tensions under different conditions. Overall, we draw attention to scaling phenomena as being integral to the development of HII and introduce a new vocabulary for thinking about HII scaling.

A key challenge in e-commerce retail is identifying a shipping fee policy that will incentivize more online orders and sales. To achieve this, retailers occasionally alter their shipping policies. While information systems research has extensively examined e-commerce channel strategies and their interplay with offline channels, it has yet to explore the online and offline implications of changes in e-commerce shipping policies. Against this backdrop, we studied a shipping policy change designed to incentivize higher-dollar orders, specifically, a large multichannel retailer’s shift from a tiered online shipping policy to a flat-rate policy. Using rich customer-level panel data and a regression discontinuity in time approach, we demonstrate that a flat-fee online shipping policy, counterintuitively, shifts sales away from the online channel and toward the offline channel—generating 23% more offline sales across 21,028 customers in five states. Evidence from additional analyses corroborated an account based on two mechanisms: an online order aggregation effect, wherein flat-fee shipping encouraged shipping fee-sensitive shoppers to aggregate purchases into larger orders, and an offline store interpurchase effect, wherein order aggregation generated longer interpurchase periods, during which customers met their needs for smaller purchases by visiting offline stores. Thus, a flat-rate shipping policy can serve as an unexpected lever for driving multichannel behavior. These findings contribute to the e-commerce channel interplay literature within information systems research and have important implications for legacy retailers seeking to leverage their brick-and-mortar investments to fend off competition from online-native retailers such as Amazon.com.