Widening the divide through digital health innovation? A Towards Health Futures PDW at AoM

Towards Health Futures: Widening the divide through digital health innovation?​

We invite researchers to submit extended abstracts (2-5 pages) to our professional development workshop  “Towards Health Futures: Widening the divide through digital health innovation?” at Annual Meeting of the AOM in Seattle, USA (Aug 5-9). Abstracts are due on July 15, 2022 via e-mail to hannes.rothe@icn-artem.com

This PDW (professional development workshop) engages workshop attendees to debate and get feedback on their research related to the role of digital technologies for producing healthcare that ensures “healthy lives and promote well-being for all at all ages” (SDG 3, UN). In particular, the PDW is aimed at examining accessibility to digital innovation in healthcare, i.e., access to the digital innovation process and access to digital innovation as health services. While many have seen the healthcare industry struggle, digital technologies are constantly evolving and finding new applications in healthcare (Das, 2019). Since the COVID-19 pandemic has started, we have seen an increasing pace in which digital innovations have emerged (Oborn et al. 2021; Thomas et al., 2020). At the same time, the pandemic has also revealed tremendous disparities in access to innovations for different groups within and between our societies (e.g., Rosenbaum 2020). To this point, there seems to be no equal access to the innovation processes, the new products and services, or the fruits of these digital innovations. This is in so far surprising as digital technologies carry the potential to raise accessibility by reducing transaction costs and enabling decentral decision making. In order to produce digital innovations for a more inclusive healthcare, diverse participants including private sector actors are needed to invest and share data in common infrastructures and engage in joint service delivery. We invite scholars to reflect on the entrepreneurial efforts and environments needed for these health futures. 

Background

We ask scholars to reflect on accessibility of health services. Access can mean different things in terms of innovative digital health care services, e.g., financial access, digital literacy, and internet access, or involvement in the innovation process. Even though different digital systems are becoming part of health care around the world, almost half of the world’s population is still without access to the internet: only 45% of people are connected in developing countries, and in the least developed countries the proportion is a mere 20% (Makri, 2019). This digital divide is further exacerbated in minority, rural, and low-income populations with lack of health literacy, i.e. ability to find and understand medical information (Babaian, 2019). This is demonstrated by a study that found nearly half of Americans are sceptical of the benefits of Health information technologies — such as wearables, patient portals and mobile apps (Mackert et al, 2016). Studies show that ”while individuals of higher socio-economic status are the first to adopt and benefit most from the introduction of innovative technologies in health, thereby creating and widening existing inequities, the digital divide tends to affect the same individuals and population groups who are at risk of social and health inequities (low income, low education, low literacy, ethnic minority groups, socially marginalised and underserved groups etc.) ” (EU, 2019, p. 66)

A broad set of digital technologies is being brought to use for innovating healthcare, such as telehealth, mobile technologies, AI, blockchain, health wearables, electronic health records tools, healthcare transportation, 3D printing, genomics and vertical integration (Sturman, 2018). These technologies promise data analytics in diagnostics and health services, distant treatment, personal health tracking, predictive healthcare, data storage on blockchain, or federated learning of health applications (e.g., Reddy, 2019). However, access to these technologies is not evenly distributed due to regulatory restrictions, intellectual property rights, lack of financial access or digital literacy. At the same time, people’s daily environments even in the least economically prosperous areas have become saturated with digital devices that track mundane activities (walking, eating, sleeping) and feed data for various health indicators. This digital data is increasingly combined with electronic medical records and genomics along with social media data for instance. Collectively such data may create real prospects for preventive personalized services that better cater to the needs of individual people. Past practice on designing medical treatment and diagnostic tools, however, have largely been blind to sex and gender differences, differing ethical backgrounds or other factors of diversity (Schiebinger & Schraudner, 2011; Vitale et al., 2017). While more and more genome data is being collected worldwide in bio banks and centralized databases (Jarvenpaa & Markus, 2018), even well-funded data collection in diverse countries such as in the UK remain heavily biased–with ninety-four percent of participants being white (Kaiser & Gibbons, 2019). Even health care data on global phenomena such as COVID remain fractured due to national regulation or platform governance mechanisms (Blotenberg et al. 2021).

Inclusivity and access to benefits of digital innovation have long been a challenge in emerging economies (Sahay and Walsham 2004).  At the same time, this has spurred on frugal forms of innovation (Prabhu 2017; Radjou et al 2012), which challenge our assumptions about healthcare services and help to promote better levels of inclusivity. For example, the Aravind Eye hospitals in India, one of the largest global providers of eye care, provide free, or highly subsidized care, for 50% of all its patients. By developing new business models, optimizing tele-medicine treatment and services and partnering with rural communities to influence the stigmas and barriers associated with access, this entity has used numerous digital innovations to radically transform how, when, where and why services are provided. Importantly these new forms of care involve new organizational forms which develop out of locally adapted ecosystems. These forms of services push our understanding of how divides related to digital innovation, and its possible benefits, might relate to new forms of organising, hybrid organisations and sustainable social innovation (Barrett, Oborn and Orlikowski 2016). Furthermore, these flexible new forms of care and service delivery depend on the development and use of mobile health applications and concomitant infrastructures (Holeman and Barrett 2017).  

If we seek a to produce digital innovations that lead to more inclusive healthcare, different participants including private sector actors are needed to invest and share data in common infrastructures and engage in joint service delivery. What type of entrepreneurial efforts might be needed and what type of business models are viable to create inclusive digital innovations?  In what kinds of environments (economic, legal, political, cultural) can we expect inclusive digital innovations take root, how inclusive and equitable will they be? Who will be the winners and losers when capturing the value of digital innovations?

Workshop agenda

(1) Brief introduction

(2) Panel session focusing on diverging methodological views on the phenomenon
The following scholars have agreed to join the panel: Eivor Oborn (Warwick University, United Kingdom), Ilias Pappas (University of Agder, Norway), Youngjin Yoo (Case Western Reserve University, USA), Ritu Agarwal (University of Maryland), Andrew Burton-Jones (The University of Queensland, Australia)

(3) Roundtable session 
The hybrid roundtable session consists of online and offline roundtables on which the extended abstracts of a selected set of authors will be discussed. Initial feedback from commentators, including Brian Pentland (Michigan State University, USA), Anna Essen (Stockholm School of Economics, Sweden), Panos Constantinides (University of Manchester, United Kingdom), Aaron Baird (Georgia State University, USA), Michelle Carter (Washington State University, USA), Lauri Wessel (European University Viadrina Frankfurt, Germany), Polyxeni Vassilakopoulou (University of Agder, Norway)

(4) Concluding reflections
Participants report from conversations at the roundtables with recommendations for governance and policy that increase inclusiveness (or limit exclusiveness).

Panelists

Andrew Burton-Jones is a Professor of Business Information Systems at the UQ Business School, University of Queensland. Andrew conducts research on how organizations can use information systems more effectively, how to improve systems analysis and design methods, and how to improve theories and methods in the IS discipline. Over the last decade, much of his work has focused on the digital transformation of healthcare. He is a Fellow of the Association for Information Systems, Fellow of the Academy of the Social Sciences in Australia, and Editor-in-Chief of MIS Quarterly. During the panel, he will explore the proposition that digital health innovation contributes to widening the divide in the context of ‘precision prevention’ (Canfell et al. 2021).  Precision prevention is an innovative vision for healthcare that is motivated by using the power of consumer-centred, real-time data, to enable new ways to identify, assess, and improve population health outcomes, making disease prevention and wellbeing initiatives matter.  On one hand, precision prevention should help reduce disparities because it moves the focus away from the acute-care sector (where many biases are already built-in) and deliberately looks for differences among consumer cohorts.  On the other hand, precision prevent could simply reinforce existing biases if it is not enacted mindfully.  I will discuss how this might occur and propose safeguards that could help.

Ritu Agarwal is Distinguished University Professor and the Robert H. Smith Dean’s Chair of Information Systems at the Smith School of Business, University of Maryland. She is also the founding director of the school’s Center for Health Information and Decision Systems (CHIDS). Her current research focuses on the use of information technology in healthcare settings, health analytics, and artificial intelligence applications in health. In addition to publishing her research in journals such as Information Systems Research, MIS Quarterly, Management Science, Journal of the American Medical Informatics Association and Health Affairs, Agarwal has made presentations at a variety of national and international conferences. She has been the National Science Foundation ADVANCE Professor for Maryland Smith and won the university’s Distinguished Scholar-Teacher Award. In 2017 she was appointed as a Distinguished University Professor, Maryland’s highest academic honor. Agarwal served a six-year term as editor-in-chief of Information Systems Research, one of the world’s top academic journals in information systems. Other editorial appointments include senior editor at MIS Quarterly and associate editor for Management Science. In 2010 Agarwal started the annual Conference on Health IT and Analytics (CHITA). This conference is a leading research forum at the intersection of technology, analytics and health. CHITA attracts international scholars, policymakers and business executives who work in healthcare reform. Agarwal is deeply passionate about using her research capabilities and advocacy to improve the practice and delivery of healthcare.

Eivor Oborn is current Professor of Healthcare Management in the area of Innovation and Organisational Change at Warwick Business School, UK. She earned her PhD at Cambridge Judge Business School, University of Cambridge in 2006, and is currently an honourary Fellow at Cambridge Judge Business School and Fellow at the Cambridge Digital Innovation Centre (CDI). Eivor is Senior Editor at MISQ and has published work in leading journals, including Academy of Management Journal, Organization Science, Information Systems Research and MISQ. Her research interests span the fields of healthcare, online communities, digital innovation & ICTs, as well as entrepreneurship in ecosystem contexts. She teaches in the area of Change Management, Strategic Health Leadership and Corporate Entrepreneurship.  During the panel, she will cover how digital technologies change healthcare delivery, including what services are accessible, and to whom. She is going to focus on geographical issues associated with access. Geographic influence on access is more than distance, but also shapes transportation challenges, connectedness of family and kin network, and centrality of decision makers in care. She will draw on empirical examples of Cancer Care in the Arctic North, immersive pediatric care in Israel that extends into Gaza communities, and care for eye injuries in cosmopolitan London. With telemedicine as a focal digital innovation, Eivor will address in each empirical case access how transportation challenges are circumvented (urban-rural divides); new role for kinship groups to participate in care (access for whom); where decisions for care are being (re)made (access to what).

Ilias Pappas is a Professor of Information Systems at the Department of Information Systems, University of Agder (UiA), Norway. His research activities include data science and digital transformation, social innovation and social change, user experience in different contexts, as well as digital marketing, e-services, and information technology adoption. He has published over 100 articles in peer reviewed journals and conferences and has been a Guest Editor for several journals. On the panel, Ilias shares his view that we need to be able to capture the complexity inherent within the interactions among the multiple actors in different types of environments to improve our understanding of inclusiveness to digital health innovation. Employing a research approach that includes asymmetric and configurational-focused case-outcome theory construction can help identify the multiple necessary and sufficient conditions that explain the same outcome for different groups of individuals (or organisations). Next, to narrow the digital divide, he will argue that we will need to take actions that will ensure inclusiveness of these individuals, especially the non-experts, in the design and development of the digital innovations, starting from the problem formulation all the way to the formalisation of the learning.

Youngjin Yoo is the Elizabeth M. and William C. Treuhaft Professor of Entrepreneurship and professor of information systems in the Department of Design & Innovation at the Weatherhead School of Management, Case Western Reserve University. He is the faculty director of xLab. He is also a WBS Distinguished Research Environment Professor at Warwick Business School, UK, and a visiting professor at London School of Economics and Political Science, UK. His work was published in leading academic journals such as MIS Quarterly, Information Systems Research, or, Organization Science, and he is senior editor at leading journals such as MIS Quarterly, the Journal of AIS and Journal of Information Technology. His research interests include digital innovation and entrepreneurship, ethical AI, digital health, and organizational genetics. During the panel, Youngjin shares insights from his studies on the design of a decentralized data ecosystem (from technology and business perspectives) that offers highly personalized dynamic digital health services. It is built on the principle of ownership and portability of data. He sees a the shift from a highly centralized data ecosystem that we currently have to a decentralized data ecosystem as an opportunity for addressing access and other societal challenges for different stakeholders including patients, providers, and tech suppliers.

Chairs

Sirkka L. Jarvenpaa is the Bayless/Rauscher Pierce Refsnes Chair in Business Administration at the McCombs School of Business, The University of Texas at Austin.  She is an AIS fellow and LEO Award recipient. Professor Jarvenpaa’s research focuses on inter-organizational collaboration in fast paced and technologically complex knowledge environments. Her work has appeared in leading information systems, management, accounting, marketing, psychology, and anthropology journals.

Hannes Rothe is Associate Professor for Information Systems at ICN Business School. He is co-founder of the Digital Entrepreneurship Hub (with Freie Universität Berlin). Hannes’ research interests lies on organizing data and knowledge, digital entrepreneurship, and digital infrastructures. His work has been published in journals such as Journal of the Association for Information Systems, Strategic Management Journal, Information Systems Journal, Communications of the AIS, and others.

Virpi Kristiina Tuunainen is a professor of Information Systems Science at the Department of Information and Service Management of Aalto University School of Business. She is an AIS fellow Award recipient. Her current research focuses on ICT enabled or enhanced services and digital innovation.  Her work has appeared in journals, such as, MIS Quarterly, MISQ Executive, Communications of the ACM, Journal of Management Information Systems, Journal of Strategic Information Systems, and Information & Management, and in conferences, such as, ICIS, ECIS and HICSS. She currently serves as senior editor for EJIS and for JAIS. 

Chairs

Sirkka L. Jarvenpaa
Professor, University of Texas at Austin, USA

Hannes Rothe
Professor, ICN Business School, Berlin / Paris / Nancy,  Germany / France

Virpi Kristiina Tuunainen
Professor, Aalto University School of Business, Finland

Panelists

Andrew Burton-Jones (The University of Queensland, Australia)

Eivor Oborn (Warwick University, United Kingdom)

Ilias Pappas (University of Agder, Norway)

Ritu Agarwal (University of Maryland, USA)

Youngjin Yoo (Case Western Reserve University, USA)

 

Commentators

Brian Pentland (Michigan State University, USA)

Anna Essen (Stockholm School of Economics, Sweden)

Panos Constantinides (University of Manchester, United Kingdom)

Aaron Baird (Georgia State University, USA)

Michelle Carter (Washington State University, USA)

Lauri Wessel (European University Viadrina Frankfurt, Germany)

Polyxeni Vassilakopoulou (University of Agder, Norway)

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