port the conclusions found in other studies in the U.S. A ‘leadership and culture’
hypothesis was not a part of this research
project. It is our feeling that this might be
an important factor for the level of digitalization in hospitals in the Netherlands. This
may be a subject for subsequent research.
LIMITATIONS OF THE STUDY
FOR FURTHER RESEARCH
There are limitations to our study. First,
although we achieved a 77% response rate,
the hospitals that did not respond to our
survey were somewhat different from those
that did respond. Given that non-respond-ing hospitals were more likely to have characteristics associated with lower levels of
adoption of EHRs, residual bias may have
led us to overestimate adoption levels.
Little is known about governance characteristics and organizational performance for EMR adopters. 21, 22 As pressures
about healthcare quality and related costs
increases dramatically in the Netherlands,
it may be of value to examine hospitals with
a sophisticated EMR and compare those
hospitals to similar hospitals (with a less
sophisticated EMR) to understand the
association between EMR capabilities and
IT governance characteristics. Presence
and length of stay of key ICT players like
CMIO and CIO in the hospital organization may be a good indicator to investigate
and test a related hypothesis. We did not
measure presence and length of stay of
key ICT players in this project. So testing
of this hypothesis was not part of this study.
Rube van Poelgeest is a Researcher at Julius
Center, Public Health, UMC Utrecht.
Lorren Pettit is Vice President, Market Research, for
Rob J. de Leeuw is a Psychologist/Senior
Researcher at Julius Center, Public Health, UMC
Guus Schrijvers is a health economist and former
professor of public health at the University Medical
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