Inter-organizational systems analysis to improve time-critical public services: The case of mobile emergency medical services

Time-critical services to the public (e.g. emergency medical services (EMS)) rely increasingly upon cooperating organizations and electronic information to deliver an integrated set of timely and quality services. In order to develop appropriate information systems to support and improve inter-organizational end-to-end delivery of these services, there is a need to understand how organizations share and use information. This study utilizes the time-critical information services (TCIS) framework to explore inter-organizational information sharing in EMS. The framework highlights socio-technical dimensions of information sharing, including operational, organizational and governance factors.; A field study was deployed that examined two U.S. case studies of county-wide EMS systems. Performance data and interviews allowed for inter-organizational business process and information flow analysis to understand operational systems. A second phase of research included in-depth interviews to explore the context of information exchanges. Individual and cross-case analyses were performed, interview data organized into themes, and findings extracted along operational, organizational, and governance dimensions.; The case studies illustrate promising factors that can enhance information sharing across organizations, while noting that considerable gaps remain in achieving an end-to-end IT-enabled performance approach. The most prevalent gap exists between "pre-hospital" and "hospital" environments. In terms of operational dimensions, the dynamic, time-critical, and multi-variable nature of emergency medical work creates technology usability challenges that result in a conservative approach to new information and technologies. Organizational findings indicate that inter-organizational alignment, including shared goals and cooperative agreements, facilitates information sharing while issues of trust and cultural differences create gaps. Governance dimensions include the need for clear lines of inter-organizational authority and accountability, which enhances information sharing and technology usage. Future research directions should include understanding how to overcome usability constraints that confront professionals working in time-information critical circumstances.; From a theoretical perspective, this study found that a public service IOS may provide the most value when extended across an entire service chain, as opposed to only one, or a few, service chain segments. From an applied perspective, the research illustrates the utility of the TCIS framework as an IOS analysis and design tool to extract business processes, information exchanges, and a depth of relative context.