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that may affect beliefs and attitudes at different
stages of the adoption process. Those that have,
stress its importance and the need for further study.
For example, Venkatesh and Davis (2000) report
that the same variables had different effects at
different stages of the adoption process, and
Fichman and Kemerer (1999) emphasize the need to
capture the time of deployment instead of, or in
addition to, time of acquisition as the bases for
diffusion modeling, driven the observed pattern of
cumulative adoptions varies depending on which
event in the assimilation process (i.e. acquisition or
deployment) is treated as the adoption event.
Further, Agarwal and Prasad (1997) support this
view that intention-based models may not explain
user adoption behavior at the different stages of the
adoption process.
Based on this evidence, the current study
considers the Rogers’ (1995) stage-based diffusion
of innovation model to be the most appropriate to
guide its investigation of the formation and change
over time of user attitudes and subsequent
acquisition and deployment decisions.
Everett Rogers defines diffusion as “the process
by which an innovation is communicated through
certain channels over time among the members of a
social system” (Rogers, 1983, p.5) where innovation
has been described as an idea, material, or artifact
perceived to be new by the relevant unit of adoption
(Zaltman, Duncan, and Holbek, 1973). There are
two types of communication channels have been
influential in diffusing technology – mass media
channels and interpersonal channels. Mass media are
radio, television, newspapers, and so on, which
enable a source of one or a few individuals to reach
an audience of many. And interpersonal channels are
face to face, telephone, and personal networks. In his
review of innovation diffusion, Rogers (1995)
reported mass media channels were most influential
in introducing potential adopters to an innovation,
whereas interpersonal channels were more
influential in subsequent stages.
Innovation diffusion research postulates that
many different outcomes are of interest in
technology adoption, including the initial adoption,
the subsequent routinization and infusion of the
innovation. This view is consistent with the stage
model as proposed and empirically validated by
Cooper and Zmud (1990). These stages of
implementation (as shown below) are not
necessarily sequential, and should be considered
activities that may occur in parallel (Cooper &
Zmud 1990):
• Initiation – Analyzing organizational needs
and potential IT solutions
• Adoption – Negotiating to get
organizational backing for IT
implementation
• Adaptation – Developing, installing and
maintaining the IT application,
revising/developing organizational
procedures, training of end-users
• Acceptance – Inducing the organizational
members to use the technology
• Routinization – Encouraging the use of the
IT application as a normal activity
• Infusion – Effective use of the technology
results in the intended benefits (increased
organizational effectiveness) of the IT
being obtained.
Initiation, adoption and adaptation require both
managerial and end-user input and buy-in, and the
remaining three stages require necessary dialogues
between organizational members for progression
through each stage to occur. Additionally, it is
widely recognized that successful implementation
depends upon gaining organizational members’,
targeted as end-users of the innovation, appropriate
and committed use of an innovation (Leonard-
Barton and Deschamps 1988; Klein and Sorra 1996).
It is through the development of a critical mass of
individual routinization and infusion that eventual
organizational infusion of an innovation is achieved
(Tornatzky and Fleischer 1990; Klein and Sorra
1996), and organizational benefits might then be
obtained.
Based on the situation in Hong Kong’s clinical
practices, most private clinics are either solo
practices or partnerships of a few medical doctors
that are small in size. Thus the respective process on
EPR initiation, adaptation and acceptance are rather
straight forward. In this regard, we would like to
focus our study on the other three different stages:
adoption, routinization and infusion on EPRs in
supporting medical practice.
The measure on adoption is based on whether
the organization has implemented any EPR.
Routinization is measured by the usage of the EPR
according to the daily tasks of a clinic. Infusion is
measured by the extent of the EPR being integrated
with other internal systems within the clinic or
external systems outside the clinic. Moreover, the
antecedents on these three essential stages will be
identified.
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