IDEAS home Printed from
   My bibliography  Save this article

Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in U.S. Hospitals


  • Corey M. Angst

    () (Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556)

  • Ritu Agarwal

    () (Robert H. Smith School of Business, University of Maryland, College Park, Maryland 20742)

  • V. Sambamurthy

    () (Eli Broad College of Business, Michigan State University, East Lansing, Michigan 48824)

  • Ken Kelley

    () (Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556)


We use a social contagion lens to study the dynamic, temporal process of the diffusion of electronic medical records in the population of U.S. hospitals. Social contagion acknowledges the mutual influence among organizations within an institutional field and implicates information transmission through direct contact and observation as the mechanisms underlying influence transfer. We propose hypotheses predicting a hospital's likelihood of adopting electronic medical records as a function of its susceptibility to the influence of prior adopters, the infectiousness or potency of influence exerted by adopting hospitals, and its social and spatial proximity to prior adopters. Results obtained by fitting a heterogeneous diffusion model to data from a sample drawn from an annual survey, spanning 1975 to 2005, of almost 4,000 U.S. hospitals suggest that diffusion can be accelerated if specific attention is given to increasing social contagion effects. In particular, with respect to susceptibility to influence, greater hospital size and age are positively related to the likelihood of adoption for nonadopters, whereas younger hospitals are associated with greater infectiousness for adopters. A hospital's "celebrity" status also contributes to its infectiousness. We further find strong effects for social proximity and significant regional effects for spatial proximity and hospital size, suggesting that geographical covariates should be included in diffusion studies. Results also reinforce the importance of theorizing about and including interactions in examinations of social contagion.

Suggested Citation

  • Corey M. Angst & Ritu Agarwal & V. Sambamurthy & Ken Kelley, 2010. "Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in U.S. Hospitals," Management Science, INFORMS, vol. 56(8), pages 1219-1241, August.
  • Handle: RePEc:inm:ormnsc:v:56:y:2010:i:8:p:1219-1241

    Download full text from publisher

    File URL:
    Download Restriction: no

    References listed on IDEAS

    1. Robert G. Fichman & Chris F. Kemerer, 1997. "The Assimilation of Software Process Innovations: An Organizational Learning Perspective," Management Science, INFORMS, vol. 43(10), pages 1345-1363, October.
    2. BarNir, Anat & Gallaugher, John M. & Auger, Pat, 2003. "Business process digitization, strategy, and the impact of firm age and size: the case of the magazine publishing industry," Journal of Business Venturing, Elsevier, vol. 18(6), pages 789-814, November.
    3. Breschi, Stefano & Lissoni, Francesco, 2001. "Knowledge Spillovers and Local Innovation Systems: A Critical Survey," Industrial and Corporate Change, Oxford University Press, vol. 10(4), pages 975-1005, December.
    4. Christophe Van den Bulte & Stefan Stremersch, 2004. "Social Contagion and Income Heterogeneity in New Product Diffusion: A Meta-Analytic Test," Marketing Science, INFORMS, vol. 23(4), pages 530-544, July.
    5. Amalia R. Miller & Catherine Tucker, 2009. "Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records," Management Science, INFORMS, vol. 55(7), pages 1077-1093, July.
    6. Gautam Gowrisankaran & Joanna Stavins, 2004. "Network Externalities and Technology Adoption: Lessons from Electronic Payments," RAND Journal of Economics, The RAND Corporation, vol. 35(2), pages 260-276, Summer.
    7. Robert D. Dewar & Jane E. Dutton, 1986. "The Adoption of Radical and Incremental Innovations: An Empirical Analysis," Management Science, INFORMS, vol. 32(11), pages 1422-1433, November.
    8. E. Burton Swanson, 1994. "Information Systems Innovation Among Organizations," Management Science, INFORMS, vol. 40(9), pages 1069-1092, September.
    9. Thomas Doring & Jan Schnellenbach, 2006. "What do we know about geographical knowledge spillovers and regional growth?: A survey of the literature," Regional Studies, Taylor & Francis Journals, vol. 40(3), pages 375-395.
    10. Marion Debruyne & David J. Reibstein, 2005. "Competitor See, Competitor Do: Incumbent Entry in New Market Niches," Marketing Science, INFORMS, vol. 24(1), pages 55-66, December.
    11. Erik Brynjolfsson & Lorin M. Hitt, 2000. "Beyond Computation: Information Technology, Organizational Transformation and Business Performance," Journal of Economic Perspectives, American Economic Association, vol. 14(4), pages 23-48, Fall.
    12. Gary P. Pisano & Richard M.J. Bohmer & Amy C. Edmondson, 2001. "Organizational Differences in Rates of Learning: Evidence from the Adoption of Minimally Invasive Cardiac Surgery," Management Science, INFORMS, vol. 47(6), pages 752-768, June.
    13. Elena Huergo & Jordi Jaumandreu, 2004. "How Does Probability of Innovation Change with Firm Age?," Small Business Economics, Springer, vol. 22(3_4), pages 193-207, April.
    14. van den Bulte, C. & Stremersch, S., 2003. "Contagion and heterogeneity in new product diffusion: An emperical test," ERIM Report Series Research in Management ERS-2003-077-MKT, Erasmus Research Institute of Management (ERIM), ERIM is the joint research institute of the Rotterdam School of Management, Erasmus University and the Erasmus School of Economics (ESE) at Erasmus University Rotterdam.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Davide Secchi & Nicole L. Gullekson, 2016. "Individual and organizational conditions for the emergence and evolution of bandwagons," Computational and Mathematical Organization Theory, Springer, vol. 22(1), pages 88-133, March.
    2. Cano-Rodríguez, Manuel & Márquez-Illescas, Gilberto & Núñez-Níckel, Manuel, 2017. "Experts or rivals: Mimicry and voluntary disclosure," Journal of Business Research, Elsevier, vol. 73(C), pages 46-54.
    3. Fareed, Naleef & Bazzoli, Gloria J. & Farnsworth Mick, Stephen S. & Harless, David W., 2015. "The influence of institutional pressures on hospital electronic health record presence," Social Science & Medicine, Elsevier, vol. 133(C), pages 28-35.
    4. Karine Lamiraud & Stephane Lhuillery, 2016. "Endogenous Technology Adoption and Medical Costs," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1123-1147, September.
    5. Fabrizio, Kira R. & Hawn, Olga, 2013. "Enabling diffusion: How complementary inputs moderate the response to environmental policy," Research Policy, Elsevier, vol. 42(5), pages 1099-1111.
    6. Jay J. Shen & Charles B. Moseley, 2012. "Organisational factors associated with adoption of comprehensive and basic electronic-record systems in US hospitals," International Journal of Public Policy, Inderscience Enterprises Ltd, vol. 8(1/2/3), pages 92-105.
    7. repec:kap:atlecj:v:45:y:2017:i:4:d:10.1007_s11293-017-9557-3 is not listed on IDEAS
    8. Ben-Assuli, Ofir, 2015. "Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments," Health Policy, Elsevier, vol. 119(3), pages 287-297.
    9. repec:bla:srbeha:v:34:y:2017:i:1:p:51-61 is not listed on IDEAS
    10. Liangjie Zhao & Wenqi Duan, 2014. "Simulating the Evolution of Market Shares: The Effects of Customer Learning and Local Network Externalities," Computational Economics, Springer;Society for Computational Economics, vol. 43(1), pages 53-70, January.
    11. Carole Roan Gresenz & Scott P. Laughery & Amalia Miller & Catherine E Tucker, 2015. "Health IT and Ambulatory Care Quality," Working Papers WR-1131, RAND Corporation.
    12. van den Oever, Koen, 2017. "Uncharted waters : A behavioral approach to when, why and which organizational changes are adopted," Other publications TiSEM 0136c8c2-ecdd-4f82-8ca7-d, Tilburg University, School of Economics and Management.
    13. repec:spr:infosf:v:17:y:2015:i:5:d:10.1007_s10796-014-9497-2 is not listed on IDEAS
    14. repec:enr:rpaper:0013 is not listed on IDEAS
    15. Thomas Koslowski & Jens Strüker, 2011. "ERP On Demand Platform," Business & Information Systems Engineering: The International Journal of WIRTSCHAFTSINFORMATIK, Springer;Gesellschaft für Informatik e.V. (GI), vol. 3(6), pages 359-367, December.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:inm:ormnsc:v:56:y:2010:i:8:p:1219-1241. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Mirko Janc). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.