Date of Award

Fall 2013

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Industrial Engineering

First Advisor

Vincent G. Duffy

Committee Chair

Vincent G. Duffy

Committee Member 1

Ji Soo Yi

Committee Member 2

Michael Yu Zhu

Committee Member 3

Mark Lehto

Committee Member 4

Daniel DeLaurentis


The US healthcare system has serious issues in care quality and patient safety. Patients often do not receive the care they need or the given care service cause harm. In addition, the significant amounts of medical and medication errors occur, and recurring adverse drug events due to damaging side effects from medications threaten patient safety. To solve these issues, healthcare information systems (HIS) have been recommended in various care processes. Though several studies have confirmed the benefits and usefulness of the systems (Cordero, Kuehn, Kumar, & Mekhjian, 2004; Kohn, Corrigan, & Donaldson, 2000; Sittig, Krall, Kaalaas-Sittig, & Ash, 2005; Weiner et al., 1999), unexpected negative outcomes, such as system related errors, communication errors, and decreased time with patients (Bates et al., 1999; Kaushal, Shojania, & Bates, 2003; Weiner et al., 1999), and low adoption rate are another issues to achieve the goals of HIS (DesRoches et al., 2008; Jha et al., 2009). Hence, HIS adoption process needs a new perspective to understand unique environments of healthcare domain, and systematic approach to investigate different types of barriers interfering successful adoption to maximize the benefits of HIS.

In Study 1, influencing factors to implement bar coded medication administration system were investigated to suggest a customized system adoption model for HIS. Based on qualitative analysis of care practitioners' interviews, HIS adoption process need to understand by patient and practitioners' perspectives.

Additionally, the effects of perceived ease of use plays a role as significant as that of perceived usefulness, which is a different result from the adoption of other information systems.

In Study 2, the effects of interruptions between two different types of tasks were examined as a system oriented barrier to adopt HIS. The interruptions from information system easily cause harmful effects on users' cognitive and physical work process and they work as barriers for successful system adoption. This study measured the level of negative effects from interruptions, and task similarity is a key factor to affect task performance. Comparing cognitive tasks, skill tasks make more errors but task completion time is not significantly affected.

In Study 3, the causes of non-compliance behaviors in use of the bar code medication administration system were categorized as user oriented barrier to adopt the system. The causes are grouped into the five categories: Poor Usability, Poor Physical Ergonomic Design, Poor Information Integrity, Adverse Environment, and Lack of Awareness. These categories are useful to understand types of system structure-based causes of non-compliance behaviors in HISs.

This dissertation highlights the importance of understanding the adoption process of HISs. It proposes suggestions to reduce the reluctance to use the systems and strategies to minimize unintended negative outcomes.