Dr. Trent Spaulding of the Department of Nutrition and Healthcare Management and three colleagues recently completed research to be published in the journal Decision Support Sysetms regarding the adoption of information technology in U.S. hospitals.
In the hospital environment, electronic health records (EHR) are made up of many different, smaller systems or functions. Hospitals often implement these smaller systems individually or in small groups in order to reach the goals of full automation. The study used data on more than 140 hospitals over 10 years. It evaluated the effects of the order of adoption on costs and revenues. Dr Spaulding and his co-authors suggest that some hospitals pay more attention to organizational factors while others focus on operational excellence. Most of the hospitals showed a tendency to favor organizational factors by first implementing systems where administration has the most organizational power. The analysis also showed that hospitals which favored organizational factors had more positive effects on net income than did hospitals which favored operational factors.
Hospitals are very complex organizational environments. Physicians, administrators, nurses, and many others have different incentives and very strong identities. According to Dr. Spaulding, the findings of this study suggest that it may be more expensive to ignore political boundaries than it is to focus on traditional operational measures related to process quality and efficiency. The study does not suggest that operational factors should be ignored. Wise decision makers will recognize the importance of respecting organizational boundaries in the process of implementing electronic health records.
This work is particularly relevant in today’s environment. The HITECH Act enacted as part of the American Recovery and Reinvestment Act of 2009 provided $18 billion in incentives to implement and use EHRs. The rate of adoption of EHRs has jumped significantly over the last year in order to take advantage of this incentive and avoid penalties in 2017.
The study was accepted at the journal Decision Support Systems. It is in press and due for publication in 2013. The article is available at ScienceDirect.