Use of Grounded Theory in Health Informatics - Department of ...

Use of Grounded Theory in Health
Informatics
Elizabeth BORYCKI a,1 , Craig KUZIEMSKY b , Elizabeth CUMMINGS c ,
Pernille BERTELSEN d
a School of Health Information Science, University of Victoria, British Columbia,
Canada.
b Telfer School of Management, University of Ottawa, Ottawa, Canada
c. eHealth Services Research Group, University of Tasmania, Hobart, Australia
d Department of Development and Planning, Virtual Centre of Health Informatics,
Aalborg University, Denmark,
1. Introduction
Abstract. The value of utilising qualitative research approaches to identify, describe
and evaluate the impact of HISs upon healthcare processes is becoming increasingly
clear. The use of grounded theory (GT) as a research and evaluation
methodology has increased over the past decade within the health informatics discipline.
However, for researchers new to the approach, the theory and conduct of
grounded theory can be both confusing and daunting. One of the significant challenges
with using GT in health informatics research is that many studies have used
variations of GT such as a ‘grounded theory guided’ or a ‘grounded approach’
[1,2]. While these variations have extended the use of GT in health informatics
they have also added to the confusion as to when GT is an appropriate method and
how it should be used.
Keywords. Grounded theory, methodology, qualitative research, health informatics
A number of qualitative methods have been used effectively in health informatics to
design and develop health information systems (HIS) [1], and identify, describe and
evaluate the impact of HISs on healthcare processes and outcomes [2]. These qualitative
methods include ethnography, grounded theory, and case study research.
Grounded theory (GT), as a qualitative approach, has demonstrated utility when applied
to systems design and development as well as evaluation in terms of the impacts
of HIS upon healthcare. Methodologically, GT’s use in health informatics has evolved
since its first introduction to this discipline in the early 1990’s (e.g. [3,4]). Its frequency
of use in health informatics has grown, as researchers have applied the methodology
and used it to inform systems design and evaluation work [4]. Although GT’s use has
grown in popularity, many researchers and health informatics professionals are unfamiliar
with the methodology in terms of its application and use in informing HIS design,
development and evaluation. The purpose of this workshop will be to provide
researchers with an opportunity to learn about GT as a methodology to the design, de-
1 Corresponding Author
23 rd International Conference of the European Federation for Medical Informatics
User Centred Networked Health Care - A. Moen et al. (Eds.)
MIE 2011 / CD / Workshops

velopment and evaluation of HIS. The workshop will provide participants with the opportunity
to explore the fundamentals of grounded theory and then apply the methodology
using a hands-on approach.
2. Goal of the Workshop
The workshop will provide researchers and health informatics professionals with an
opportunity to learn about grounded theory as a methodology for HIS design, development
and evaluation through lectures and a hands-on experience in using the methodology
in a supported group environment. The workshop leaders will draw on uses of
GT to provide insight to different ways GT can be used in health informatics studies.
3. Objectives
The objectives of the workshop are as follows:
1. To outline the historical development of GT as a methodology, including how GT
was first introduced into HIS research and later into health informatics.
2. To provide an overview of its current uses with examples from real-world projects,
including the use of software tools such as NVivo and Atlas.
3. To provide an overview of the typical design of a GT study
4. To provide participants with an opportunity to sketch out a grounded theory
4. Format of the Workshop
The workshop will be comprised of lectures when the underlying theory and history of
grounded theory will be described as well as hands-on exercises that will allow participants
to learn about how to design a GT study, analyse data using grounded theory approaches
and present grounded theory data. Real world examples will be employed.
4.1. Involved Speakers
The workshop will be lead by researchers who have employed grounded theory:
Dr. Elizabeth Borycki teaches Research Methods in the health informatics graduate
program at University of Victoria and has experience in the use of GT for evaluation of
HIS. Elizabeth will provide the historical background and discuss general use of GT.
Dr Craig Kuziemsky has expertise in the use of GT to develop ontologies for HIS design.
Craig will present about the use of GT for gathering requirements to inform modeling
and HIS design.
Dr Elizabeth Cummings has experience in using GT in evaluation of HIS at multiple
levels and will present about the use of GT for HIS evaluation from experiences.
Dr. Pernille Bertelsen has experience in the use of GT and in conducting interactive
workshops. Pernille will facilitate the interactive portions of the workshop.

4.2. Subject Domain to be Discussed
The term ‘theory’ adds to the intrigue of this method as it raises the question do all GT
studies actually need to produce a theory? Or can GT merely be used as an approach to
analyse qualitative data? Perhaps more important is the question ‘is a theory always a
necessary outcome from using GT, or is theory based GT more relevant to the social
sciences where GT first emerged’? Although a classic tenet of GT is data analysis
without any conceptual biases we are seeing more health informatics studies using supplementary
theories to provide granularity to the data analysis. GT is void of any specific
theoretical underpinning and some researchers argue that our understanding of
healthcare should incorporate existing theories where appropriate. For example, Reddy
et al. used socio-technical theory to make GT analysis more meaningful by drawing out
relationships between social and technical features of inter-team coordination [5].
A challenge observed in studies that purport to use GT is that they frequently do
not provide illustrations of how GT was used such as providing examples of coded data.
Although GT becomes a means of implied rigor for research studies there are few examples
that actually show details of methodological rigor. It is common for studies in
healthcare to state they used a ‘grounded theory approach’ yet they offer no methodological
insight as to how the data was coded to inform the results. The use of GT in
these papers is unfortunate as they do little to further the use of GT as a health informatics
method and in fact may imply that using GT is easier than it actually is.
5. Expected Achievements and Outcomes
Following completion of this workshop, the participants will have an understanding of
GT to identify applications of the methodology. The participants will be able to: (1)
design a grounded theory study, (2) be able to analyse data collected using grounded
theory approaches, (3) present this data, and (4) incorporate the findings into HIS design
and development work as well as use the information gathered from the study to
inform future health information systems improvements.
Statement of Participation: All of the workshop speakers are committed to participating in the
conference.
References
[1] Kuziemsky, C.E., Downing, G.M., Black, F.M., Lau, F. A Grounded Theory Guided Approach to Palliative
Care Systems Design. International Journal of Medical Informatics 76S (2007),S141–S148
[2] Ash, J.S., Gorman, P.N., Lavelle, M., Stavri, P.Z., Lyman, J., Fournier, L., Carpenter, J. Perceptions of
Physician Order Entry: Results of a Cross-Site Qualitative Study. Methods Inf Med 42 (2003), 313–23
[3] Mead, G.H., Mind, self, and society. The University of Chicago Press, Chicago, 1934.
[4] Cummings, E., Borycki. E., Grounded theory evolution and its application in health informatics. Studies
in Health Technology and Informatics 164 (2011), 286-92
[5] Reddy, M.C., Paul, S.A., Abraham, J., McNeese, M., DeFlitch, C., Yen. J. Challenges to effective crisis
management: Using information and communication technologies to coordinate emergency medical
services and emergency department teams International Journal of Medical Informatics 78(4)
(2009), 259-269.