Table 1.

Framework for conceptualizing drivers of and barriers to health IT adoption

	Investment	Implementation	Use
Strategic Level	§ Alignment with organization’s strategic vision	§ Alignment with organizational model for care delivery	§ Learning strategy for the use of knowledge and information made available § Cultural reform to provide “psychological safety”
Operational Level	§ Expectations regarding the organization’s capacity for change § Expectations regarding managerial instrumentality over organizational/workflow changes	§ Employee involvement §Devolution of authority §Organizational learning capacity	§ Creation and maintenance of an innovative, “mutual gains” employment contract § Managerial practices that incentivize and promote broad health IT use and ongoing learning
Frontline Level	§ Skills and abilities to use the technology § Staffing adequacy § Existence of appropriate work structures	§ Perceived preparedness for technological change § Perceived employment and wage security	§ Maintenance of skill levels § Continued trust in employee involvement mechanisms § Promoting point-of-contact learning and feedback