Communication and Compliance in the contexts of Extreme Events and Healthcare
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Communication and Compliance is very important in all domains and walks of life. This dissertation investigates communication and compliance using computer based information systems in two distinct domains: Extreme Events and Healthcare. In the Extreme Events domain, this thesis focuses on Campus Emergency Notification Systems. Over the past decade a number of high profile events such as active shooting incidents, occurrences of robberies, building fires, rapes, etc. has brought the issue of campus safety to the forefront. Colleges have responded by deploying campus emergency notification systems in large measure. In fact, research conducted by the U.S. Federal Bureau of Investigation indicates that between 2005 and 2008, some 220 counts of murder or negligent manslaughter, more than 14,000 sex offenses, 19,900 robberies, and 4,045 arson incidents were reported to the Department of Education in compliance with the Clery Act. Specifically, this thesis address two critical questions that are relevant in the context of dealing with campus related emergency communication. 1. What are the critical factors that impact the adoption of emergency notification systems? 2. What are the critical antecedents that motivate students to comply immediately with campus emergency notification systems (ENS) message? The second domain is healthcare. The prevalence and incidence of diabetes mellitus have been increasing substantially in the United States. The total estimated costs of diagnosed diabetes in the United States in 2007 were $174 billion, and this amount increased to $245 billion in 2012. Research has identified significant gaps in the quality of care for diabetic patients - these gaps can be viewed as a compliance problem. Compliance with the recommended care has two steps. First, the physician needs to order the care (such as a laboratory test or other service). Next the patient must follow through on the order and complete the test or other recommended care. This paper investigates how the use of an electronic disease registry within an electronic health record in primary care can address both steps. This thesis is composed of three essays that attempt to address these issues. The first two essays are investigations in the area of Campus Emergency Notification Systems. The third essay is in the area of healthcare. Essay # 1: The first thesis essay addresses the issue of adoption of campus emergency notification systems. The increasing number of campus incidents has kindled a realization among university officials of the need for better communication with students at such trying times. This study uses the technology, organization and environment (TOE) framework and the theory of channel complementarity to develop an insight into the factors that contribute to social network adoption intention and to examine the relationship between traditional channels and social network sites in the context of emergency response. Essay # 2: The second thesis essay deals with the factors that lead to greater student compliance with emergency notification systems. This essay provides a deeper understanding of student behavior with regard to adherence to the messages in situations varying from rapidly developing (Fire and Active Shooter) to slowly developing (Snowstorm) incidents. The paper adapts Etzioni's Theory to develop a conceptual model. The essay uses a multi-method approach to draw conclusions that inform both theory and practice. Essay # 3: The third thesis essay investigates whether the use of electronic diabetes registries meeting Meaningful Use core objectives in primary care practices is associated with differences in compliance to recommended care, and outcomes of care. The study examines the use of registries for both steps in compliance with recommended care: (1) registries for 'quality improvement', to encourage physician ordering of recommended care; and (2) registries for patient reminders, to encourage patient follow-through on ordered care. A practice assessment survey was conducted to identify whether and how practices were using electronic diabetes registries. Insurance claims data from 2010 were used to examine compliance with recommended care and health outcomes for patients in practices that used diabetes registries to drive compliance compared to patients from practices that did not use registries. Conclusions: The major finding from the first essay is that the environmental context variable (incident rate on campus) and the technology context variable (traditional channels deployed on campus) affect the intention to adopt Social Network Systems (SNS) for emergency notification purposes. This result suggests that schools with a higher incident rate on campus are more likely to consider using SNS to communicate with students during emergencies. The results also show that enrollment is not related to SNS adoption intention. From a cost management perspective, the most popular SNS services today are free to organizations and individual users. The building and monitoring activities are also relatively cost effective. Schools do not need to invest very much to get services up and running. The major finding from the second essay is that subjective norm and information quality trust are critical factors that positively influence immediate compliance. The second thesis essay adapts Etzioni's theory to provide a deeper understanding of the antecedents to immediate compliance. It introduces "information quality trust" as an important predictor of immediate compliance. The results also reveal that the important factors affecting compliance vary by the type of campus emergency. Further, the results also show that friends have lower influence than parents and university officials in all types of incidents. This finding is counterintuitive, as it might be expected that peer pressure in young adults would have a stronger impact (Lu et al., 2003; Scharl et al., 2005). It seems that the context of emergencies changes the impact of peer (friends) pressure. When comparing parents and university officials, university officials have higher influences in active shooter, building related and robbery incidents. The major finding from the third dissertation essay suggests that for type 2 diabetic patients, the use of an electronic registry to generate patient reminders was associated with an improved rate of compliance with laboratory testing and dilated retinal exams that are recommended as part of routine diabetes care. Use of registries for quality improvement purposes, was not associated with improved compliance with care but, importantly, was associated with reduced avoidable hospital utilization and Emergency Department visits. The results indicate that the use of a disease registry to intervene with patients was effective at improving compliance with recommended care. Interestingly, the registry function focused on driving physician behavior which did not appear to influence compliance with routine care but did improve health outcomes. The study provides evidence to support the investments and financial incentives to implement disease registries.