H2: As environmental competition
increases, the likelihood of having
advanced EMR capabilities increases.
The level of competition in an external
environment, according to Resource
Dependency theory, is a large predictor of
organizational strategy and action. In an
area with a great deal of competition, hospitals must compete for the same resources, thus making inputs potentially scarcer
and placing hospitals under more pressure to distinguish themselves from competitors, thus securing their market share
of patients. If patients have more choices,
they may elect where to go for healthcare
and will likely choose a hospital that offers
new or better services such as EMRs. Hospitals may reason that EMRs will make
them more appealing to the patient population in an area of high competition where
patients have choices of where to receive
care. In the Netherlands the bargaining of
hospital services is done exclusively by the
healthcare insurance companies. In some
areas certain healthcare insurance companies have a prevalent position.
H3: Larger hospitals are more likely to
have advanced EMR capabilities.
Perhaps the greatest barrier to hospital
EMR adoption is the cost of implementation and maintenance. With adequate
financial resources, hospitals are likely
more able to purchase the often-expensive
EMR systems and equipment. However,
not all hospitals have the financial means to
implement and use complete EMR systems.
Those with smaller operating margins are
less likely to have the funds to buy and
implement EMRs. Organizational power
is often associated with organizational
■ n Population density
■ n Competition
■ n ICT budget
■ n Number of ICT employees
■ n Financial resources
■ n Hospital size
■ n Teaching status
■ n Leadership and culture?