The proposed IOS implementation model derived from Cooper and Zmud's (1990) single organization model is able to capture the some aspects of CHIN implementation. The model, however, seems best suited to less competitive market situations where there is recognition that competition does not necessarily preclude interorganizational cooperation. Further, my results suggest that competition is the overriding factor in the model, thereby implying that not all variables in the model are equally important. Health care organizations in some more competitive markets have yet to rationalize the web of players (e.g., physicians and production workers, payors, providers, patients, government, and larger external environment) that directly affect its (in)ability to form cooperative ventures. The case data indicate that large health care providers and payors in some markets are evolving toward less cooperative, more coercive IOS strategies. These organizations mandate IT direction, infrastructure support, and the degree to which competitors will form cooperatives. This is evident in emerging health care organizations, such as Healtheon/WebMD and CyberCare.
These results, while interesting, must be viewed as preliminary. This was an exploratory study and was limited to CHINs located in the Midwest. CHINs implemented in what the industry considers more advanced health care states, such as Oregon, Minnesota and California, are characterized by a high degree of managed care and competition, and potentially can be impacted by a different set of conditions. Thus, another implementation model or subset of the current model may be more appropriate, and these results may not be applicable in more mature health care markets. Moreover, these early CHIN efforts speak to the challenges the industry faces as we enter the age of customer (patient) relationship and supply chain models that stand to debunk archaic views of care delivery, patient as primary consumers, information privacy, and data management.