Introduction

As the cost of healthcare has soared in the United States, rising to $2 trillion or 16% of GDP in 2005 (CMS, 2007), the role and use of healthcare information technology (HIT) has come into increased focus. HIT, in this context, refers to a wide range of clinical systems such as electronic medical records (EMR), computerized physician order entry (CPOE), and pharmacy information systems, and administrative systems such as patient billing systems, budgeting systems, and scheduling systems, that are expected to streamline healthcare delivery to patients, improve healthcare quality, and reduce delivery costs. In the report presented to the U.S. Congress by the Medicare Payment Advisory Commission (2004), HIT was identified as having the potential to significantly improve the quality, safety, and efficiency of healthcare. A similar report by the National Health Leadership Council (2005) identified HIT as the critical foundation for promoting health system reform, generating productivity and performance improvement, and producing significant cost reduction in healthcare expenditures.

As healthcare organizations face increasing pressure to invest in HIT, many healthcare managers are struggling to find ways to motivate physicians, nurses, and administrators to use the implemented HIT. Clearly, technology deployment is futile if users do not use the technology, use it inappropriately, or find ways to circumvent its usage. For instance, in 2003, doctors at the prestigious Cedars-Sinai Medical Center at Los Angeles rebelled against their newly installed CPOE system, complaining that the system was too great a distraction from their medical duties, forcing the withdrawal of a system that was already online in two-thirds of the 870-bed hospital (Freudenheim, 2004). The Leapfrog Group (an advisory group associated with the National Academy of Sciences) estimated that, of the nation's 300 non-governmental hospitals (6% of all hospitals in the U.S.) that have implemented comprehensive HIT systems, only 40 of these systems (less than 1%) are routinely used by of doctors for ordering prescriptions and laboratory tests (Freudenheim, 2004).