Organizational Learning during IT Outsourcing: Evidence from EMR Implementations

Abstract

This paper examines factors affecting organizational learning rates for outsourced EMR implementations in a quasi-experimentally chosen group of New York nursing homes. We combine detailed support request data collected by the EMR vendor in charge of implementing the systems with survey responses on work practices from 962 employees in the fifteen selected nursing homes. The vendor classified the tickets into “implementation problems”, associated with errors in the software provided by the vendor, and “usage problems” caused by incorrect usage of the new systems by the nursing home employees. We find that both types of support requests declined over time at a diminishing rate. Implementation issues declined with total vendor experience, and declined anew with the vendor’s experience in each new client implementation. Client-side work practices promoting employee discretion, teamwork, skill development, and information sharing accelerated the decline in usage problems. Over the entire implementation period, a one standard deviation higher work practices measure was associated with 10% fewer tickets arising from incorrect employee usage.

Keywords: Electronic Medical Records, Healthcare IT, IT Adoption, Organizational Learning, Organizational Complements