ing the requirements of EMRAM Stage 6
(Closed loop medication administration
[CLMA] and decision support [CDSS]).
Progressing past EMRAM Stage 5, CLMA
must be live in all inpatient units (EMRAM
Stage 7 requirement) or at least in one clinical unit (EMRAM Stage 6 requirement).
Only 11 hospitals in the NL had surpassed
EMRAM Stage 5 requirements during the
time of this study. Note that in March 2015,
one NL hospital successfully met all of the
requirements to satisfy EMRAM Stage
7 (UMC Radboud in Nijmegen), becoming the third hospital in all of Europe to
achieve this distinction (Hospital de Dénia
Marina Salud in Denia, Spain, University
Medical Center Hamburg-Eppendorf, Germany, and RadboudUMC in Nijmegen, The
Netherlands).
RESULTS OF TESTS
REGARDING THE HYPOTHESES
University hospitals in the Netherlands
are a special group. They have different
financial models, have special teaching and
research missions, and are in general a lot
larger than other hospitals in the NL. They
combine IC T efforts for healthcare, educa-
tion, and research, and have more advanced
ICT organizations; although, some are
struggling with the more advanced posi-
tion. Teaching hospitals and general hospi-
tals are more focused on patient through-
put than university hospitals; this has to do
with the different missions and financial
model. For this reason the university hos-
pitals were excluded, with the exception of
hypothesis H4, where those hospitals are
compared with the other hospitals.
H1: Hospitals in a lower population
density area are less likely to have
advanced EMR capabilities.
The ‘Randstad’ area of NL (defined by the
area around Amsterdam, The Hague, Rotterdam, and Utrecht, with 40% of the total
population of the Netherlands) has a much
higher concentration of individuals (
population density =3267/km2) than the other
regions of the country (average population
density of the non-Randstad region = 1186/
km2) (see Table 3). In comparing the EMR
profiles of the densely populated Randstad
region hospitals to hospitals in the other
lower densely populated regions, we find
no support for our first hypothesis. On
the contrary, the lowest scoring hospitals
( 52.2% versus 30.2%) are in areas of higher
population density.
H2: As environmental competition
increases, the likelihood of having
advanced EMR capabilities increases.
The ‘Randstad’ area of NL (defined by the
area around Amsterdam, The Hague, Rotterdam and Utrecht with 40% of total population of the Netherlands) has the highest
concentration of hospitals in all of NL. With
the density of hospitals per 10km in the
Randstad area equaling 4. 5, compared to a
hospital density of 1.3 in the non-Randstad
area, 17 the findings of this study provide
no support for the hypothesis that EMR
adoption increases based on environmental competition (Table 4). On the contrary,
the non-Randstad area generally presents
as having a more advanced EMR profile as
the largest grouping of hospitals in the non-Randstad area (58.1%) are in Stage 3-5, while
in the Randstad area 52.2% are in Stages 1
and 2.
H3: Larger hospitals are more likely to
have advanced EMR capabilities.
Although not statistically significant, the
general pattern emerging from this study
(Table 5) supports the hypothesis that larger hospitals tended to have more advanced
EMR capabilities than smaller hospitals.
This pattern is reflected in the number of
staffed beds.
competition
density
Average
number of
hospitals
within a
10km area
Stage 0-2 Stage 3-5 Stage 6 and 7
Count Row N Count Row N Count Row N
non-Randstad1.3 13 30.2% 25 58.1% 5 11.6%
Randstad 4. 5 12 52.2% 8 34.8% 3 8.3%
Non-Randstad region has more digital potential.
Stage 0-2 Stage 3-5 Stage 6 and 7
Mean Row N Count Mean Row N Count Mean Row N Count
numberofbeds 422 37.9% 501 50.0% 582 12.1%
number of beds
0<340<562
large 28.6% 6 57.1% 12 14.3% 3
medium 30.8% 8 57.7% 15 11.5% 3
small 57.9% 11 31.6% 6 10.5% 2
Larger hospitals tended to have more advanced EMR capabilities than smaller hospitals.
