Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department (Legacy)

Department of Interdisciplinary Studies

Committee Chair

Dos Santos, Brian L.

Author's Keywords

Whole network; Information system; Health information exchange; Interorganizational system; Interorganizational network


Health--Information resources; Health--Information services; Information networks


Background: Failure to achieve their goals of over 200 U.S. Health Information Exchange Networks (HIENs) which formed or operated in the U.S. from 2004 to 2010, lost time, capital and opportunity at individual, organizational and societal levels, and a lack of theory driven research on HIENs underscores a need for research to better understand factors affecting development of these kinds of large, complex collaborations. Purpose: A new dual network participation theory is developed by combining three source theories. The new theory supports integrated consideration of organizational and technological factors which affect participation by individuals and their affiliated organizations in complex collaborations like HIENs. Research questions are formulated focused on advancing knowledge about: types of participation in HIENs; validity of variables used to operationalize the theory; barriers and enablers to participation in HIENs; and implications for theory and research. Method: A retrospective, theory-driven, multi-level, multi-case, mixed methods case study is done using a convenience sample of 6 HIEN sites (network level), 109 individuals (individual level) and 125 organizations (organizational level). Qualitative data is analyzed to develop valid ordinal variables and test hypotheses for each case. Valid ordinal variables are entered into SPSS. A principle component analysis is done to create combined predictor variables. An OLS regression analysis supports identification of predictor effects on intent to participate. Network level analyses identify key influences on the predictors. Findings: Network level barriers to participation include heterogeneity of participants, lack of HIEN resources, lack of qualified leadership, lack of training and education and lack of stable Network IT. Individual/organizational level barriers include lack of support from influential others, low benefit expectancy, lack of knowledge, and high cost expectancy. Recommendations are made for future research studies with enough statistical power for hypothesis testing across larger populations of sites/participants (e.g., 100-300 sites; 1,000 - 3,000 participants). Conclusions: While the use of a small, non-random sample of sites/subjects implies caution regarding generalization, the research yields new insights with implications for both practice and theory. These include preliminary recommendations for improving the success of HIENs and new opportunities for research on barriers and enablers of participation in large scale collaborations.