In a minimum of 400 words compare and contrast the three major conceptual frameworks concerning technology and task: TTF FITT and ISTA.
1.Fit between Individuals Task and Technology FITT Ammenwerth et al.
2.Interactive Sociotechnical Analysis ISTA Harrison et al.
3.Clinical Adoption Meta-Model CAMM Price & Lau
BioMedCentral
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BMC Medical Informatics and
Decision Making
Research article Open Access
IT-adoption and the interaction of task technology and individuals:
a fit framework and a case study
Elske Ammenwerth*1 Carola Iller2 and Cornelia Mahler3
Address: 1Institute for Health Information Systems UMIT University for Health Sciences Medical Informatics and Technology Hall in Tyrol
Austria 2Institute for Educational Science University of Heidelberg Germany and 3Dept. of Psychiatry University Hospitals of Heidelberg
Germany
Email: Elske Ammenwerth* elske.ammenwerth@umit.at; Carola Iller iller@ews.uni-heidelberg.de;
Cornelia Mahler cornelia_mahler@med.uni-heidelberg.de
* Corresponding author
Abstract
Background: Factors of IT adoption have largely been discussed in the literature. However
existing frameworks (such as TAM or TTF) are failing to include one important aspect the
interaction between user and task.
Method: Based on a literature study and a case study we developed the FITT framework to help
analyse the socio-organisational-technical factors that influence IT adoption in a health care setting.
Results: Our FITT framework (Fit between Individuals Task and Technology) is based on the
idea that IT adoption in a clinical environment depends on the fit between the attributes of the
individual users (e.g. computer anxiety motivation) attributes of the technology (e.g. usability
functionality performance) and attributes of the clinical tasks and processes (e.g. organisation task
complexity). We used this framework in the retrospective analysis of a three-year case study
describing the adoption of a nursing documentation system in various departments in a German
University Hospital. We will show how the FITT framework helped analyzing the process of IT
adoption during an IT implementation: we were able to describe every found IT adoption problem
with regard to the three fit dimensions and any intervention on the fit can be described with regard
to the three objects of the FITT framework (individual task technology). We also derive
facilitators and barriers to IT adoption of clinical information systems.
Conclusion: This work should support a better understanding of the reasons for IT adoption
failures and therefore enable better prepared and more successful IT introduction projects. We
will discuss however that from a more epistemological point of view it may be difficult or even
impossible to analyse the complex and interacting factors that predict success or failure of IT
projects in a socio-technical environment.
Background
It is hard to imagine health care without Information and
Communication Technology (ICT). Information technology
in health care has existed for about four decades and
has gained widespread usage. Electronic patient records
offer health care professionals access to vast amounts of
patient-related information; decision support systems
support clinical actions; and knowledge servers allow
Published: 09 January 2006
BMC Medical Informatics and Decision Making 2006 6:3 doi:10.1186/1472-6947-6-3
Received: 16 June 2005
Accepted: 09 January 2006
This article is available from: http://www.biomedcentral.com/1472-6947/6/3
2006 Ammenwerth et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
which permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited.
BMC Medical Informatics and Decision Making 2006 6:3 http://www.biomedcentral.com/1472-6947/6/3
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direct access to state-of-the-art clinical knowledge to support
evidence-based medical practice [1].
Introduction of ICT can radically affect health care organisation
and health care delivery and outcome. It is evident
that the use of modern ICT offers tremendous opportunities
to support health care professionals and to increase
the efficiency effectiveness and appropriateness of care
[23].
However not all projects introducing IT in health care are
successful. It is estimated that up to 60 70% of all software
projects fail (e.g. [4]) leading to enormous loss of
money within healthcare and also to loss of confidence on
IT from the side of users and managers.
It is interesting to recognize that the same IT system can be
seen as success by one department or professional group
but as a failure or at least as problematic by another
department or professional group. Various interconnected
factors seem to exist that influence success or failure. In
fact the notion of success and failure has been largely discussed
in the literature in the last years. We will not try to
repeat the overall discussion here but just refer to some
good references ([5-11]).
What we observe in any case is that the objective effects of
the same IT system can largely differ in different settings.
This is not surprising if we understand information systems
as technical systems embedded in a social-organizational
environment (see also [12]). The technology we are
introducing in different clinical settings can be largely
equal (e.g. the same PACS software in various radiological
departments). But the socio-organizational setting may be
quite different (e.g. different organization of workflow
different patient profiles different motivation of staff different
management support different IT history etc.)
leading to different adoption processes of the same IT system
and thus to different effects (e.g. increased efficiency
on one ward user boycott on the other ward).
What does this mean for a systematic IT management in
hospitals? We argue that it would be helpful to know
more about the factors influencing IT adoption success
and failure and to be able to predict the effects in a certain
setting.
Therefore at least two questions arise which should be
answered by medical informatics research:
1. What are the socio-organizational factors that influence
adoption of an IT system in a given socio-organizational
context?
2. Based on the answers to question 1: Is there any way to
predict the effects of an IT system in a certain context?
The aim of this paper
The aim of this paper is to present an approach to answer
the first question. Based on a literature study we will
present a framework (the FITT framework) to better analyse
the socio-organisational-technical factors that influence
IT adoption. We will present the application of this
framework in the analysis of a case study describing the
adoption of a nursing documentation system in several
departments of a German University Hospital.
With regard to the second question we will argue that
from some more philosophical point of view the exact
prediction of success and failure may not be possible at
all.
Previous work on IT adoption
Analysis of the factors influencing adoption (and thus
also success and failure) of IT systems in health care has
been an issue in research for many years. We will define IT
adoption as follows based on the discussion in [13]: for
voluntary used system IT adoption is reflected in the
usage of the IT system; for mandatory used systems IT
adoption is reflected in the overall user acceptance. In the
next paragraph we will analyse some research results on
factors for IT adoption focussing on general valid frameworks.
Analysing the concept of information system (IS) success
DeLone [5] developed an information success model for
management information systems. This model describes
that the effects of IT on the user (the individual impact)
and thus on the overall organization depends on the use
and the user satisfaction. Those two aspects themselves
depend on the quality of the IT system and the quality of
the information in this system (Figure 1). This model was
used to structure a broad literature review but seems not
to be further validated. The authors discuss that IS success
is a multidimensional construct based on the interaction
of factors and that a corresponding measurement instrument
should therefore include not only the described criteria
but also their interaction.
IFnifgourmrea t1ion success model by DeLone [5] Information success model by DeLone [5].
BMC Medical Informatics and Decision Making 2006 6:3 http://www.biomedcentral.com/1472-6947/6/3
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The information success model is quite interesting as it
describes the interaction of various factors. However its
shortcoming seems to be the isolated focus on IT quality
and system quality indicating that only the systems quality
itself determines the overall impact. This does not help
to explain why the same IT system can be adopted in a different
way and have rather different effects in various settings.
The technology acceptance model (TAM) of Davis [14] tries to analyse why users adopt or reject a system. It
defines the constructs perceived ease of use and perceived
usefulness to predict attitude towards using and
actual system use. Both factors themselves depend on features
of the system (Figure 2).
While trying to verify his model by questioning 112 users
of one company Davis [14] could partly confirm the
expected links in his model. In his discussion he stresses
that this model is only usable for voluntary use of IT system
and that further factors should be included in his
model such as extrinsic motivation user experiences with
the system and characteristics of the task to be supported
by IT (e.g. complexity of a task).
This TAM model was adopted and extended by other
researchers such as [1516] and [17]. For example Dixon
[16] extended it to the Information Technology Adoption
Model (ITAM). He tried to refine the system design
features of the TAM model by describing that an IT system
has requirements (such as required IT knowledge of
the users or necessary technical infrastructure) that must
be matched with the knowledge and skills of the users and
with the available technical infrastructure. He called this
fit and argued that perceived usefulness and perceived
ease of use are not dependent on the system design features
but on this fit of user and system design features.
The paper stays unclear whether the ITAM model was
more formally validated. It is also unclear why those
points already discussed as missing by Davis [14] (such as
extrinsic motivation or task characteristics) were not
included.
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