Health Information Technology in US Hospitals: Analysis of Current Status and Development of Future Strategies

Abstract

Adopting Electronic Health Records (EHR) improves the efficiency and quality of health care systems. However, recent studies reported a slow rate of adoption or conflicting study results regarding EHR implementation in the United States. Even though there appears to be a substantial difference in terms of EHRs implementation and adoption among hospitals with different organizational characteristics and by end-users in different job categories, little has been studied about the relationship between EHR implementation and different organizational and end-users’ characteristics.

To evaluate the current status of EHRs implementation and adoption and to compare how differences in organizational and end-user characteristics relate to EHR adoption and implementation, we analyzed secondary data from HIMSS Analytics® annual survey of 2013 and primary data from end-user surveys using various statistical analysis techniques including multivariable regression analysis, multinomial logistic regression analysis, and information theoretic analysis using normalized mutual information (NMI). This study was based on various theories including an organizational learning theory, a theory of organizational readiness for change, the Technology Acceptance Model (TAM) and Andersen and Aday’s behavioral model.

We found discernable differences in EHR implementation and adoption among hospitals with different organizational contextual factors. Most notable was a strong link between hospital location and EHR implementation. Rural hospitals lagged behind urban hospitals in terms of EHRs implementation demonstrating a lower level of readiness for meaningful use attainment. Hospitals in different locations selected and used different EHR vendors based upon location specific evidence related to attaining meaningful use. We also found that EHR end-users across different job categories had different perceptions toward EHRs, which ultimately influenced their satisfaction with EHRs.

For successful EHR implementation and adoption, health care managers need to develop and customize EHR implementation strategies. Instead of applying one uniform strategy, health care managers need to prioritize their resources and focus their efforts according to different organizational contexts and different end-user expectations toward EHRs. As rural areas will be disadvantaged in terms of quality and efficiency if rural hospitals continue to struggle with EHR implementation, we need to pay special attention to EHRs implementation in rural hospitals.