The Institutional Influences on EHR Implementation: The Case of Mission Hospital

Date of Award

December 2017

Degree Type


Degree Name

Doctor of Philosophy (PhD)


School of Information Studies


Murali Venkatesh


Electronic Health Records, Hospital, Implementation, Information Systems, Institutional Theory

Subject Categories

Social and Behavioral Sciences


This dissertation investigates the implementation of an enterprise electronic record system in Mission Hospital, a community hospital and healthcare network located in Central New York. The implementation and use of Hospital Information Systems date back to the late nineteen sixties. Over time, these technologies have become critical to the practice of documenting and managing patient health data. Underlying the importance of these systems was the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 by the United States government.

The HITECH act provided funds to eligible hospitals and healthcare providers to incentivize the adoption and use of electronic health record (EHR) systems. Provisions of the legislation also threatened a financial penalty on healthcare providers who had not become “meaningful users” of EHRs by the year 2015. EHR implementation has proven to be a complex process requiring the strategic coordination and consideration of a variety of technical and socio-political factors. Researchers have produced a long list of critical success (and failure) factors that suggest best practices of implementation. However, the alarming rates of failure reported in the literature suggest that there are still many gaps in our understanding of how and why some of these efforts succeed, while many others fail.

As such, the aim of this dissertation was to understand Mission Hospital’s strategy for implementing their EHR system. This study utilized the case method and relied on interviews conducted with the implementation project team and hospital staff. Project-related documentation served as a secondary source of data. Concepts from institutional theory provided a framework for analyzing the actions and decisions taken by the implementation project team. The findings of this study explain how the hospital’s surrounding organizational field shaped key implementation decisions, and reveal how the project stakeholders engaged in various types of institutional work which created organizational change, and furthered the institutionalization of new EHR practices.


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