Essays on Electronic Health Records (EHR) Process Framework and Design-Theoretic Model in a Multi-Stakeholder Context

The dissertation research, in two separate empirical investigations using 168 participants, examines the design and implementation of electronic health record (EHR) systems across stakeholders groups involving practitioners, patients, administrators and auditors.;The first research elaborates the process and stakeholder considerations in EHR design. It highlights and delineates 4 sequential processes of (1) scheduling patient visit, (2) reviewing patient medical records, (3) diagnosing and treating patients, (4) reporting and follow-up embodying 24 activities. In validating stakeholder differences, the study examines the gap between stakeholder perceptions of importance and perceptions of satisfaction. Findings from a detailed review suggest significant gaps in reporting and follow-up followed by diagnosing and treating patients, reviewing patient medical records, and scheduling patient visit. The gaps surface disconcerting evidence of misalignments between stakeholders, albeit required to use EHR systems for everyday operations. The gaps identified in this research is the first in this area of research to examine stakeholder needs and gaps at a granular levels of healthcare operation and practice, allowing researchers and practitioners to pinpoint process-level disparities and address mechanisms to mitigate and rectify them.;The second research complements the first by extending the research by identifying the interplay and relationships between stakeholder expectations of satisfaction and stakeholders' openness to use. In the process, the research follows a design theory to extract meta-kernels and kernels with 3 EHR system characteristics across 11 specific features. As a part of the kernel exposition, the research forwards a hypothesized framework.;Findings surface a positive relationship between expectations of EHR system availability and portability and between portability and usability. The findings interestingly highlight negative relationships between portability, security/accountability and confidentiality on openness to use because of portability, confidentiality and usability.;The findings suggest that higher expectations of EHR characteristics can often reduce stakeholder use-behavior. The findings highlight that aspects of portability, accountability and confidentiality serve as a double edged sword and suggest a fine balance in crafting operational and regulatory policies for effective use of EHR systems across stakeholders.