Peers, regulators, and professions: the influence of organizations in health information technology adoption

According to the U.S. National Research Council, current health information technology (HIT) efforts are insufficient and arguably detrimental to healthcare transformation. Many hospitals have already implemented HIT, and federal stimulus funding will further adoption efforts. Organizations become more similar through the adoption of innovations like HIT, but the effects of the changes do not necessarily improve efficiency. This view from sociology and organizational studies, called institutional isomorphism, suggests that organizations pursue changes endorsed by peers, regulators, and professional societies through mimetic, coercive, and normative mechanisms, respectively, that improve legitimacy, a socially constructed value that determines an organization's ability to obtain resources and survive. In this paper we examine mimetic, coercive, and normative influences in the adoption of three HIT innovations as well as evidence of resulting inefficiency. Institutional isomorphism provides a useful framework for researchers and practitioners to examine variation in HIT adoption.