Table 4.

Summary of the Ten Themes Identified in the Literature by Punctuated Equilibrium Component.

Identified Theme	Description	N*
Deep Structure		202
1. Variations in the environment	The environment of healthcare is defined by factors that influence the adoption and use of HIT, including provider location, size, and HIT vendor capabilities.	85
2. Market Complexity	Healthcare operates within a complex environment characterized by patient confusion, multiple social interactions, data complexity and complex reimbursement systems.	27
3. Regulatory	Regulations guide privacy and security, reporting, reimbursement, liability and standards.	43
4. Flawed Risk and Reward	Incentives to adopt HIT are flawed; inure more to payers and patients than to providers adopting the systems. Fee-for-service reimbursement norms create further disincentives.	24
5. Theories of Acceptance and Diffusion	Several models help describe the patterns of adoption and diffusion of technology within healthcare, including the Technology Acceptance Model and the Diffusion of Innovation theory among others.	27
Equilibrium		224
6. Barriers	Data sources highlighted the cost of HIT, lack of human and capital resources, and resistance to change from practitioners as barriers to transformation.	134
7. Ethical Considerations	Ethical considerations contributing to equilibrium include an obligation for technology to do no harm, benefit everyone and not limit ability to practice autonomously.	5
8. Competition and Sustainability	The market economy of the US demands a value driven business case for HIT adoption.	34
Revolution		147
9. Environmental Elements	Patient engagement and new models of care represent potential influencers of revolution within healthcare.	74
10. Internal Elements	Change requires effective management, practitioner champions, a shared vision, and a favorable organizational culture.	66

^*Data sources can reflect more than one PEq component or theme and not all data sources discussed a specific identified theme.