The productivity paradox of information technology
Communications of the ACM
Commonalities in reengineered business processes: models and issues
Management Science
International dimensions of the productivity paradox
Communications of the ACM
The substitution of information technology for other factors of production: a Firm Level Analysis
Management Science - Special issue: Frontier research on information systems and economics
The Operational Analysis of Queueing Network Models
ACM Computing Surveys (CSUR)
Information technology and economic performance: A critical review of the empirical evidence
ACM Computing Surveys (CSUR)
Productivity of Information Systems in the Healthcare Industry
Information Systems Research
Gatekeepers and Referrals in Services
Management Science
Information technology payoff in the health-care industry: a longitudinal study
Journal of Management Information Systems - Special issue: Impacts of information technology investment on organizational performance
Managing Patient Service in a Diagnostic Medical Facility
Operations Research
Investment in Enterprise Resource Planning: Business Impact and Productivity Measures
Journal of Management Information Systems
On The Economic Role of RIS/PACS in Healthcare: An Empirical Study
HICSS '09 Proceedings of the 42nd Hawaii International Conference on System Sciences
Incentives for Quality Through Endogenous Routing
Manufacturing & Service Operations Management
Division of Labor in Medical Office Practices
Manufacturing & Service Operations Management
Journal of Management Information Systems
The Hang-Over Effect in Information-Intensive Service Systems
HICSS '10 Proceedings of the 2010 43rd Hawaii International Conference on System Sciences
Research Commentary---The Digital Transformation of Healthcare: Current Status and the Road Ahead
Information Systems Research
On the impact of analyzing customer information and prioritizing in a service system
Decision Support Systems
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The literature on business process design has focused on issues such as bottlenecks, workflow configuration (series versus parallel), replacing an existing workflow with a shorter one, etc. One important issue that has not received adequate attention is the information-intensive nature of medical service systems. Performance of clinical workflows depends not only on how various steps are carried out but also on when certain information items are collected. We report the results of a long-term empirical study that looked at the implementation of a radiology information system (RIS) at a large regional network of radiology clinics. We find that a failure to gather necessary clinical background information in earlier steps significantly delays later steps and causes them to hang over, with a significant impact on the total turnaround time of diagnostic reports. We show that information systems can solve this problem by separating the task of gathering information from its usage and relocating that task upstream in the workflow. We argue that such unbundling can lead to shorter report turnaround times even if it significantly increases the utilization of the bottleneck server. These results have broader implications for the optimal design of other clinical workflows, such as the process of filling prescriptions in pharmacies or the typical surgical preanesthesia evaluation in hospitals. Finally, we explain why the impact of addressing hang-over is often nonuniform across clinical modalities, providers, and patient types.