H4: Academic affiliated hospitals
are more likely to have
advanced EMR capabilities.
Academic affiliated hospitals not only have
a higher percentage of Stage 6 and Stage 7
hospitals ( 21.2%) than general hospitals
( 10.3%), but have a much lower percentage
of hospitals in the entry EMRAM stages
( 27,3% versus 48,7% respectively) (see Table
6). These findings support the hypothesis
that hospital type tends to influence a hospital’s EMR capabilities.
H5: Hospitals with a relatively
higher ICT budget tend to have more
advanced EMR capabilities.
Findings of this study (reflected in Table 7)
support the hypothesis that hospitals with
advanced EMR capabilities tend to have
higher ICT budgets than those hospitals
with lower EMR capabilities. The budget-
ary demands appear to grow in a fairly
linear manner, raising notable concerns
worthy of future exploration.
H6: Hospitals with more ICT
employees have more advanced
EMR capabilities.
The findings of this study support the
hypothesis that hospitals with more ICT
employees tend to have more advanced
EMR capabilities. As reflected in Table 8,
the number of ICT workers per hospital
bed increases with advancing EMR capabilities. These findings unfortunately do
not detail the type of ICT workers. Future
research efforts might want to consider if
there is a shifting demand in the type of ICT
worker as hospitals progress in their EMR
capabilities.
DISCUSSION
Leveraging the HIMSS Analytics EMRAM
to define the basic EMR as one that exceeds
the infrastructure of an EMRAM Stage 5
hospital, we found that only 15.3% of NL
hospitals during our study period had a
basic EMR system in at least one clinical
area (EMRAM Stage 6). With so few NL
hospitals operating a basic EMR system,
we are left to question those factors that
might be at work influencing a hospital’s
EMR progression. This study considered
two major classes of variables: the EMRAM
requirements themselves and intervening
organizational and environmental forces.
With respect to EMRAM requirements,
the findings of this analysis suggest NL
hospitals may be particularly challenged
in addressing one distinct requirement
of the HIMSS Analytics EMRAM. With
37.5% of hospitals having successfully met
the requirements of Stage 2 but not Stage
3, the requirements of Stage 3 appear to be
a challenge for a sizeable percentage of NL
hospitals. And indeed, when looking further into the data, we find that electronic
nursing/clinical documentation presents
as a particular challenge. We are uncertain as to why so many hospitals in the
Netherlands have been apparently slow
to implement a nursing documentation
system but do question if it has something
to do with the value placed on nurses in
Dutch hospitals.
While nurses play a significant role in
patient care in a hospital, their role (and by
extension perceived value) are often times
secondary to the role of the attending physician. If true, then it is possible IT leaders
are placing a greater emphasis on EMRAM
applications targeted towards physicians
than nurses. A notable observation: physician related applications (Computerized
Physician Order Entry; Physician Documentation) are higher order applications
in EMRAM. This hypothesis certainly
warrants further exploration as there is a
strong argument to be made in prioritizing
the automation of nursing documentation,
especially as a means of reducing the trans-
Stage 0-2 Stage 3-5 Stage 6 and 7
Count Row N Count Row N Count Row N
academic
affiliated
Yes 9 27.3% 17 51.5% 7 21.2%
No 19 48.7% 16 41.0% 4 10.3%
Academic affiliated hospitals have more advanced EMR capabilities.
Stage 0-2 Stage 3-5 Stage 6 and 7
Mean Mean Mean
ICT budget in € millions 5.1914 6.7400 8.3000
ICT budget as percentage of hospital
budget 3.06% 3.63% 4.17%
Hospitals with higher IT budgets score better.
Stage 0-2 Stage 3-5 Stage 6 and 7
Mean Mean Mean
number of ICT employees per hospital bed 0.0782 0.0831 0.1015
Hospitals with more ICT employees tend to have more advanced EMR capabilities.
FALL 2015 n VOLUME 29 / NUMBER 4 n www.himss.org 44
