The Autonomy-Control Dilemma : Motivation, Ability and the Adoption of Electronic Health Record Systems by Physician Practices

The lack of timely and relevant patient information has been frequently linked to adverse treatment outcomes; hence the effective management of patient information has emerged as a strategic imperative for the healthcare industry. Healthcare informatics experts have suggested that electronic health record (EHR) systems can facilitate effective information sharing within and between healthcare stakeholders such as physician practices, hospitals, insurance companies, and laboratories. In this paper, we examine the adoption of EHRs at the level of the physician practice. Physician practices occupy a central position in the healthcare value-chain and possess a number of unique characteristics that differentiate them from other institutional contexts, including a strong "clan" culture, a potent professional and occupational identity, and a desire for autonomy. We draw upon the motivation-ability framework and self-determination theory from organizational behavior and psychology to theorize about the determinants of EHR adoption in physician practices. We use data from 218 physician practices, spread across the United States, to test our theoretical model. Results suggest that while the ability components exhibit direct effects on adoption, the motivational components and their relationships to adoption are more nuanced. Although practices may recognize that there is value associated with adopting EHRs, this motivation can be undermined by influences from external sources. Theoretical and pragmatic implications of the findings are discussed