The diffusion of information technology among health maintenance organizations

Factors that Determine Comprehensive Categorical Classification of EHR Implementation Levels

Electronic Health Records (EHRs) have the potential to alleviate patient safety mistakes. Of the various levels of EHR, advanced or higher-level functionalities of EHR are designed to improve patient safety. Certain organizational and environmental factors may pose as barriers toward implementing all of the functionalities, leaving certain hospitals intermediate between basic and comprehensive levels of implementation. This study identifies a comprehensive categorical classification that includes hospitals that have functionalities between basic and comprehensive levels of EHR and determines the organizational and environmental factors that may influence hospitals to implement one or more combinations of these categories. A longitudinal panel design was used. Ordinal logistic regression with random effects model was fitted with robust cluster standard errors. Our sample consisted of non-federal general acute care hospitals utilizing a panel design from 2010 to 2016 with 17 586 hospital-year observations (or an average of 2600 hospitals per year). Larger size hospitals, ones with higher total margin, metropolitan and urban hospitals, system affiliated hospitals, and those in higher managed care penetration areas have higher odds of belonging in one of the higher categories of EHR implementation. Hospitals that can access a greater amount of human resources and financial assets from their environments, may implement higher levels of EHR. Initial and maintenance costs of EHR, interoperability issues, and inability to distribute high costs of training across facilities may stymie implementation of higher EHR functionalities. Policymaking to encourage competition among vendors may possibly lower the implementation price for hospitals with limited resources.

A Three Country Study for Understanding Physicians' Engagement With Electronic Information Resources Pre and Post System Implementation

Deriving the benefits of electronic information resources as provided by electronic medical record systems (EMR) on a global scale is critically dependent on physicians' adoption and continued use of such resources. Yet, there is little known about the factors that motivate physicians to adopt and continue to use electronic information resources. The purpose of this article is to investigate the motivational factors leading to adoption and usage of electronic information resources in diverse regions of the world including developing countries (India and Egypt) and developed countries (the US). Based on the socio-cognitive theory and the decomposed theory of planned behavior, the authors surveyed 314 physicians in three countries in order to assess their engagement with electronic information resources. Data was analyzed via PLS for direct and indirect effects of socio-cognitive constructs and their impact on electronic information resources' use intentions. The authors' results suggest there are similarities as well as differences in factors impacting adoption and usage of electronic information resources pre and post EMR implementation in both developing and developed countries. They found that physicians' perceptions of effort expectations, technological infrastructure and support, and computer self-efficacy were the strongest direct drivers influencing intentions to use electronic information resources both in pre and post-EMR implementations in all three countries that were studied. However, a richer set of factors contributed to physicians' intentions to continue to use electronic information resources, post-EMR, in developed countries as compared to pre-EMR in developing countries. Social influences had a strong indirect effects, influencing physicians' perceptions of effort expectations post-EMR as well as perceptions of performance expectations pre-EMR implementation. Computer self-efficacy was a significant predictor of effort expectations of an electronic information resource both pre and post-EMR implementation while compatibility with physicians' practices significantly influenced performance expectations in both pre and post EMR implementations in all three countries studied. The authors' study provides important theoretical and practical implications for successful management and implementation of electronic information resources such that they are adopted and used in the healthcare environment.

The effect of payer mix on the adoption of information technologies by hospitals

BACKGROUND

Numerous studies have examined the relationship between organization characteristics and hospital adoption of information technology (IT). However, no known study has examined whether patient characteristics of those treated at a given hospital influences the decision to adopt IT.

PURPOSE

The present study combines primary and secondary data to examine the effect of payer mix (the combination of payers that make up a given hospital's patient discharges) on IT adoption in hospitals.

METHODS

Survey data from Florida hospitals were combined with the state's hospital discharge database. Multiple regression analyses were used to analyze the data.

RESULTS

When examining Medicare, Medicaid, traditional commercial insurance, and managed-care plans, only an increase of managed-care patients, as a percentage of hospital discharges, was associated with a significant increased likelihood to adopt clinical and administrative IT applications by hospitals.

PRACTICE IMPLICATIONS

Our results suggest that increasing cost pressures associated with managed-care environments are driving hospitals' adoption of clinical and administrative IT systems as such adoption is expected to improve hospital efficiency and lower costs. Given that such cost pressures are also emergent in Medicare, Medicaid, and traditional third-party payment environments, an opportunity exists for these parties to motivate hospital IT adoption as a means for cost reduction.

Perceptions of Medical Errors by Internal Medicine Residents

Efforts to identify the underlying structure of 40 survey items dealing with perceptions of medical errors are reported on the basis of responses from 195 medical residents. Factor analysis revealed that the medical errors perceptions were represented by a 10-factor solution. The external validity of these factors was examined relative to perceptions about the cost of medical errors, the cost of errors to health care, and the need for education and interventions to address errors. Results indicated that 13.9% of the variation in the perceived cost of medical errors and 17.1% of the variation in the perceived need for additional physician education was explained by the factor structure.

Exploring hospitals' adoption of information technology

This study explores the adoption of information technology (IT) and the association between organizational and market factors, and IT adoption in hospitals. Results suggest that a wide range of amounts and types of IT are adopted. Hospitals with higher overall IT adoption adopt strategic IT most often. Hospitals with lower IT adoption adopt administrative IT most often. Results also show hospital IT adoption to be positively associated with hospital size, location, system membership, ownership, and market competition.

Determinants of information technology outsourcing among health maintenance organizations

We analyze the determinants of HMO information technology outsourcing using two studies. Study 1 examines the effect of asset specificity on outsourcing for development and operation activities, using HMO specific fixed effects to control for differences between HMOs. Study 2 regresses the HMO specific fixed effects from Study 1, which measure an HMO's propensity to outsource, on HMO characteristics. The data comes from a 1995 InterStudy survey about information technology organization of HMOs. While HMOs split roughly equally in outsourcing information technology development activities, they are extremely unlikely to outsource the day-to-day operation of information systems. The greater an HMO's information technology capability and the complexity of information systems supported, the less likely is an HMO to outsource. While HMOs less than two years old, for-profit HMOs, local or Blue Cross-affiliated HMOs, and mixed HMOs are more likely to outsource, federally qualified HMOs are less likely to outsource. Policy and managerial implications for the adoption and diffusion of new ways of organizing information technology, such as application service providers (ASPs), are discussed.