A Theory of Clinic-EHR Affordance Actualization

To build theory about how to achieve expected benefits from a system implementation, we conducted a longitudinal study of the implementation of an electronic health record (EHR) system at a multi-site clinic using grounded theory methods and a critical realist perspective. We developed a mid-level process theory of how clinics actualize affordances arising from the implementation of an EHR. In so doing we complement the work of Markus and Silver (2008) in their application of Gibson’s Affordance Theory to the understanding of IT effects on organizations. Specifically, we replace the DeSanctis and Poole (1994) concept of appropriation with a new concept, actualization, and show how the individual level journeys of users as they actualize affordances as perceived from their various personal perspectives result in the organizational level outcomes. In building this mid-level theory, we identify the central affordances pertaining to the clinic-EHR relation and in so doing, provide an example of how to define affordances and how to conduct empirical studies using an Affordance Theory lens. Our theory should prove useful to practitioners implementing such systems.