organizational strategy, organizational pro-
cess, organizational culture, organizational
structure). A third major stream explores
the relationships between IT and methods
of organizing IT resources to align them
with enterprises. However, at present, we
know very little about these relationships
in hospitals.
The purpose of this study is to identify
organizational and environmental factors
that are associated with the adoption and
use of hospital EMRs. The results of this
study may guide policy and practice by identifying specific barriers to hospital EMR use.
THEORETICAL MODEL
For this study we used the Resource dependence theory model. This theory begins with
the premise that organizations are not in
control of all of the resources they need
to survive. As such, many of the organization’s strategies for survival include
attempts to reduce their dependence on
external resources in times of uncertainty
by securing necessary inputs. Moreover,
Iroju O., et al6 claim that the omnipres-ence of information and communications
technology (IC T) makes information about
quality and prices more readily available,
generally lowering dependence among
buyers and suppliers able to develop alternatives more readily. This may disturb
the power balance. We elected to apply
the Resource Dependence Theory to the
adoption of hospital EMRs because this
theory allows us to develop a fairly comprehensive model11 (see Figure 1) to identify significant predictors and barriers to
EMR use.
HYPOTHESES TO TEST
According to the Resource Dependence
theory, environmental uncertainty may
motivate organizational action or strategy. 12 Organizations in areas of greater
uncertainty are more likely to take action
to secure resources than organizations in
areas of less uncertainty. After all, organizations with certain access to necessary
resources do not need to secure inputs
from the environment, while organizations in uncertain environments must
adapt to their surroundings in order to
survive. Since EMRs may lead to better
hospital performance and outcomes as
well as increasing efficiency, some hospitals may use EMRs as a strategy to
combat this environmental uncertainty.
From this model we deducted the following hypotheses.
H1: Hospitals in a lower population
density area are less likely to have
advanced EMR capabilities.
As hospitals are scarcer in areas of lower
population areas, (potential) patients have
less choice and hospitals have less urgency
to adopt advanced technologies like EMRs.
ABSTRACT
BACKGROUND
Much research has been conducted on the organizational and environmental
factors associated with the adoption and use of electronic medical records (EMRs)
in hospitals. With much of these studies focused on U.S. hospitals, there are
limited studies at this time surrounding the adoption of EMRs in Dutch hospitals.
The purpose of this study is to profile the organizational and environmental factors
associated with the adoption and use of EMR technologies in Dutch hospitals.
METHODS
Using the HIMSS Analytics Electronic Medical Record Adoption Model
(EMRAMTM) to define a hospital’s EMR capabilities, acute care hospitals in the
Netherlands (NL) were surveyed regarding their EMR capabilities. From this data,
we determined the proportion of hospitals that had a comprehensive EMR system
in use in various clinical areas of the hospital and then examined the relationship
between the hospital’s EMR capabilities and various intervening variables to
include environmental factors, hospital characteristics and information and
communications technology (ICT) characteristics.
RESULTS
The results of this study indicate that Dutch hospitals reflect a varied array of
EMR capabilities. Of the 72 hospitals surveyed between 2012 and 2014 (77.4%
of all NL hospitals), 15.3% had a comprehensive EMR system present in at least
one clinical unit. The findings also revealed notable EMR capability differences by
organizational and environmental characteristics. Larger hospitals and academic
affiliated hospitals were more likely to have advanced EMR systems. There also
appears to be a positive association between EMR capabilities and the size of a
hospital’s IT budget.
CONCLUSIONS
The findings of this research project support studies from the U.S. that hospital
organizational and environmental factors are associated with the adoption and
use of EMR technologies. The findings generally supported half of the hypotheses
forwarded in the study design. There was no support for example for the
hypothesis that EMR capabilities in the Netherlands are positively associated
with hospital competition and population density. This latter finding suggests
the need for subsequent research studies surrounding a ‘leadership and culture’
hypothesis.
KEYWORDS
Hospital, EMR
