IT‐based clinical knowledge management in primary health care: A conceptual framework

• Author: Guy Paré,Éric Maillet,Louis Raymond
• Date: 01 October 2017
• DOI: http://doi.org/10.1002/kpm.1545
• Published date: 01 October 2017

RESEARCH ARTICLE

IT‐based clinical knowledge management in primary health

care: A conceptual framework

Louis Raymond |Guy Paré |Éric Maillet

Institut de recherche sur les PME, Université

du Québec à Trois‐Rivières, Trois‐Rivières,

Québec, Canada

Correspondence

Louis Raymond, Institut de recherche sur les

PME, Université du Québec à Trois‐Rivières,

3351, boul. des Forges P.O. Box 500, Trois‐

Rivières, QC G9A 5H7, Canada.

Email: louis.raymond@uqtr.ca

Funding information

Canada Health Infoway

Primary health care medical practices have made sizable information technology investments

in recent years, primarily deploying electronic medical record (EMR) systems as well as

Web‐based e‐learning applications. The basic assumption here is that developing information

technology‐based knowledge management capabilities may significantly improve the innova-

tion and clinical performance of these organizations. Increasing uncertainty in their environ-

ment requires them to develop greater absorptive capacity (ACAP), that is, an organizational

learning capability to deal with the external sources of this uncertainty. In applying ACAP

theory to primary care settings, this study seeks to answer the following research questions:

What are the e‐learning and EMR capabilities developed by primary care medical practices

in response to increasing environmental uncertainty? To what extent does the development

of an e‐learning capability influence the development of an EMR capability? To what extent

does building ACAP contribute to positive outcomes in terms of medical practices0innovation

and clinical performance?

1|INTRODUCTION

Public and private organizations in every industry encounter increased

environmental uncertainty and rapid changes in their external

environments, and the health care sector is no exception. In the face

of rapidly increasing health care costs, associated with an aging

population and the concomitant rise of chronic illnesses (Bodenheimer,

Wagner, & Grumbach, 2002; Pineault et al., 2014), governments in

countries with national health care systems have undertaken major

reforms. In Canada, for instance, important transformations to the

national health care system have been made to strengthen the primary

health care sector so as to improve access to care, patient and provider

satisfaction, care quality, and health care system efficiency and

sustainability (Hutchison & Glazier, 2013). More precisely, new modes

of primary health care delivery, including Family Medicine Groups and

Primary Care Network Clinics, as well as new payment models have

been introduced in several Canadian provinces.

To cope with environmental uncertainty, organizations are

investing in information technology (IT) to increase their information

processing capacity and their flexibility to adapt to environmental

changes (Karimi, Somers, & Gupta, 2004). In this regard, to lower their

operating costs, increase the efficiency and quality of health care

services provided to their patients, and respond to the increased

requirements of governments and other key stakeholders, primary care

medical practices in several countries have made sizable investments in

health care IT. Medical practices have primarily deployed electronic

medical record (EMR) systems (Ludwick & Doucette, 2009; Schoen

et al., 2012; Shen, 2012), as well as Web‐based e‐health care

applications (Romanow, Cho, & Straub, 2012) mostly in the form of

clinical knowledge management systems (Wills, Sarnikar, El‐Gayar, &

Deokar, 2010) and clinical decision support systems (Berner, 2009).

In primary health care settings, EMR systems are viewed as the

backbone infrastructure supporting the integration of various tools

that can improve the uptake of evidence into clinical decisions. These

systems are meant to support patient‐centered care, the coordination

of such care, and the exchange of clinical information to improve the

quality of care (Holroyd‐Leduc, Lorenzetti, Straus, Sykes, & Quan,

2011; Lau et al., 2012). For their part, e‐health care applications such

as clinical knowledge management system and clinical decision support

system are meant to improve physicians0knowledge management

skills (Reed, Schifferdecker, & Homa, 2008) and support their decision

making, allowing them to make clinical decisions that are more

consistent, sound, and evidence‐based (Lobach et al., 2012). Yet there

are remaining problems with regard to the extent to with which EMR

systems and e‐health care applications are used in an effective and

mindful manner in primary care settings, and with the attainment of

clinical value or benefits from such use (Paré et al., 2014; Venkatesh,

Zhang, & Sykes, 2011). This situation may simply be related to a “lack

of awareness,”as an important gap has been found between the

functionalities available in EMR systems and those actually being used

DOI: 10.1002/kpm.1545

Knowl Process Manag. 2017;24:247–256. Copyright © 2017 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/kpm 247