Aligning Effectively: The Case of Electronic Medical Records

Co-evolutionary IS-alignment (COISA) is a relatively new approach to understanding business-IT alignment (BITA) in complex environments. It is defined as continuously exercised alignment processes, characterized by co-evolutionary interactions between different IS stakeholders, in pursuit of a common interpretation and implementation of what it means to apply IT in an appropriate and timely way, in harmony with strategies, goals, and needs. This concept is well applicable in hospitals, given their many different stakeholders and quickly changing environments. For example, although hospitals heavily invest in advanced Electronic Medical Records (EMR), it remains unclear how EMR should align with the strategies, goals, and needs of hospitals and its stakeholders. Earlier work has shown that COISA may be a useful lens in revealing the manifestation of stakeholder interactions behind alignment during EMR implementations. However, it is insufficient only to assess the manifestation of COISA interactions, as this is no guarantee that these interactions are effective in pursuing alignment. Our study reveals facilitators of efficacious COISA interactions during EMR implementations, using theoretical insights on BITA, COISA and efficacious dynamics in complex organizations and empirical insights from a single case study and three focus groups. Our findings reconcile and complement existing knowledge, specifically for EMR implementations.