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Hu X, Qu H, Houser SH, Chen H, Zhou J, Yu M. Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals. Risk Manag Healthc Policy 2020; 13:295-301. [PMID: 32308512 PMCID: PMC7135123 DOI: 10.2147/rmhp.s241553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52–3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22–2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34–2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.
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Affiliation(s)
- Xuejun Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huoliang Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Jinming Zhou
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Min Yu
- Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, People's Republic of China
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Behkami N, Daim TU. Exploring technology adoption in the case of the Patient-Centered Medical Home. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Andrews AL, Kazley AS, Basco WT, Teufel RJ. Lower rates of EMR use in rural hospitals represent a previously unexplored child health disparity. Hosp Pediatr 2014; 4:211-6. [PMID: 24986989 DOI: 10.1542/hpeds.2013-0115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Rural hospitals face significant barriers to adoption of advanced-stage electronic medical records (EMRs), which may translate to an unexplored disparity for children in rural hospitals. Our objective was to determine whether children hospitalized in rural settings are less likely to be cared for using advanced-stage EMRs. METHODS We merged the 2009 Healthcare Cost and Utilization Project Kids Inpatient Dataset with the 2009 Healthcare Information and Management Systems Society database. Logistic regression determined the independent relationship between receiving care in a rural hospital and advanced-stage EMRs. RESULTS A total of 430 055 (9.3%) of the 4 605 454 pediatric discharges were rural. Logistic regression analysis determined that even when an extensive list of various patient and hospital characteristics are accounted for, rurality continues to be a strong predictor of a child's care without advanced-stage EMRs (odds ratio 0.3; 95% confidence interval, 0.2-0.5). CONCLUSIONS Children hospitalized in a rural hospital are less than half as likely to be treated using advanced-stage EMRs. A focus of government and hospital policies to expand the use of EMRs among rural hospitals may reduce this child health care disparity.
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Affiliation(s)
| | - Abby Swanson Kazley
- Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
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Hart V. Hospital IT Sophistication Profiles and Patient Safety Outcomes. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2013. [DOI: 10.4018/jhisi.2013010102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Information technology (IT) sophistication of acute care hospitals in Texas was measured to explore the relationships between IT infrastructure and patient outcomes using Donabedian’s framework. The sample was acute care hospitals (n=175) with an IT profile using HIMSS, demographic and operations data. Three dimensions of hospital IT sophistication were measured and related to patient care outcomes using the AHRQ Patient Safety Indicators (PSI). Significant relationships (p < 0.05) using linear regression were found between hospital IT sophistication and three PSI measures. A review of similar studies during the same time period in Iowa, Georgia, and Florida compares findings from two instruments used to profile hospital IT infrastructure. This study adds to and confirms findings of positive relationships between IT sophistication of hospitals and patient care outcomes using the AHRQ safety indicators. Discussion of the conceptual model and the IT sophistication construct provides a theoretical framework for this line of research.
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Affiliation(s)
- Valeria Hart
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA
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Abstract
BACKGROUND : Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. PURPOSES : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. METHODOLOGY/APPROACH : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. FINDINGS : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). PRACTICE IMPLICATIONS : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.
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Holmes GM, Pink GH. Adoption and perceived effectiveness of financial improvement strategies in critical access hospitals. J Rural Health 2011; 28:92-100. [PMID: 22236319 DOI: 10.1111/j.1748-0361.2011.00368.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain the use and perceived success of strategies to improve the financial performance of Critical Access Hospitals (CAHs). METHODS Information about the use and perceived effectiveness of 44 specific strategies to improve financial performance was collected from an online survey of 291 CAH Chief Executive Officers and Chief Financial Officers. Responses were merged with financial and operational characteristics of the respondents' hospitals obtained from Medicare cost reports. Use rates and perceived success and failure were calculated for each strategy. A cluster analysis was applied to classify strategies based on their use and success. Finally, CAH characteristics were examined to predict the use of individual strategies. FINDINGS Financial improvement strategies are pervasive among CAHs. The administrators who responded to the survey in this study reported using an average of 17.0 of the maximum 44 strategies listed in the survey questionnaire. Revenue/cost, human resource, and capital strategies were more frequently used than service expansion and reduction strategies. Overall, CAH characteristics did not explain the use or perceived success of specific strategies, but they did partially predict the number of strategies attempted. CONCLUSIONS CAH administrators have used multiple strategies to improve financial performance with a wide variety of reported success. More research into the effectiveness of specific interventions is needed to help administrators select evidence-based strategies.
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Affiliation(s)
- George M Holmes
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7411, USA. mark
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McCullough J, Casey M, Moscovice I, Burlew M. Meaningful Use of Health Information Technology by Rural Hospitals. J Rural Health 2011; 27:329-37. [DOI: 10.1111/j.1748-0361.2010.00359.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
In light of new federal policies allowing hospitals to subsidize the cost of information systems for physicians, we examine the relationship between local hospital investments in information technology (IT) and physician EMR adoption. Data from two Florida surveys were combined with secondary data from the State of Florida and the Area Resource File (ARF). Hierarchal logistic regression was used to examine the effect of hospital adoption of clinical information systems on physician adoption of EMR systems after controlling for confounders. In multivariate analysis, each additional clinical IT application adopted by a local hospital was associated with an 8% increase in the odds of EMR adoption by physicians practicing in that county. Given this existing relationship between hospital IT capabilities and physician adoption patterns, federal policies designed to encourage this more directly will positively promote the proliferation of EMR systems.
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Teufel RJ, Kazley AS, Basco WT. Early adopters of computerized physician order entry in hospitals that care for children: a picture of US health care shortly after the Institute of Medicine reports on quality. Clin Pediatr (Phila) 2009; 48:389-96. [PMID: 19224864 DOI: 10.1177/0009922809331801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine national estimates of computerized physician order entry (CPOE) use for 2003 in hospitals that care for children. DESIGN Retrospective cohort analysis. RESULTS Six percent of the hospitals used CPOE (119 out of 2145). Children's hospitals are more likely to use CPOE than a children's unit (odds ratio [OR] = 6; 95% confidence interval [CI] = 1.5-23.9). Private for-profit hospitals are more likely to use CPOE than public hospitals (OR = 26.5; 95% CI = 3.1-224.8). Urban teaching hospitals are more likely to use CPOE than rural hospitals (OR = 3.9; 95% CI = 1.7-8.8). Hospitals in the Northeast, Midwest, and South are more likely to use CPOE than hospitals in the West (OR = 11.2, 95% CI = 4.8-26.5; OR = 4.2, 95% CI = 1.7-10.5; OR = 3.1, 95% CI = 1.5-6.3, respectively). CONCLUSIONS In 2003, 6% of the hospitals that care for children reported using CPOE. Early adoption of CPOE was associated with children's hospitals, private hospitals, urban-teaching hospitals, and hospitals outside of the western region.
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Affiliation(s)
- Ronald J Teufel
- Department of Pediatrics and Internal Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Harrison JP, McDowell GM. The role of laboratory information systems in healthcare quality improvement. Int J Health Care Qual Assur 2009; 21:679-91. [PMID: 19055276 DOI: 10.1108/09526860810910159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the status of US hospital Laboratory Information Systems. Laboratory Information Systems are critical to high quality healthcare service provision. Data show that the need for these systems is growing to meet accompanying technological and workload demands. Additionally, laboratory tests provide the majority of information for clinical decision-making. Laboratory processes automation, including patient result verification, has greatly improved laboratory test throughput while decreasing turn-around-times, enabling critical results to reach physicians rapidly for improved clinical outcomes. DESIGN/METHODOLOGY/APPROACH Data were drawn from the 2007 Healthcare Information and Management Systems Society (HIMSS) Analytics Database, which includes over 5,000 US healthcare organizations and provides extensive data on the hardware, software, and information technology infrastructure within healthcare organizations. FINDINGS US hospitals are actively involved in laboratory systems planning to improve health service quality. Specifically, data show 76 new laboratory information systems are currently being installed in 2007 with another 399 under contract for future installation. As a result, increasing investment in laboratory information systems is providing state-of-the-art clinical laboratory support, which enhances clinical care processes and improves quality. These state-of-the-art Laboratory Information Systems, when linked with other clinical information systems such as Computerized Physician Order Entry and Electronic Medical Record, will support further healthcare quality improvement. ORIGINALITY/VALUE This article includes the most current information available on the US hospital laboratory information system applications.
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Affiliation(s)
- Jeffrey P Harrison
- Department of Public Health, University of North Florida College of Health, South Jacksonville, Florida, USA.
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Information technology capacities assessment tool in hospitals: Instrument development and validation. Int J Technol Assess Health Care 2009; 25:97-106. [DOI: 10.1017/s0266462309090138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:This research integrates existing literature on information technology (IT) in hospitals, and proposes and validates a comprehensive IT capacities assessment tool in these settings.Methods:A comprehensive literature review was conducted on Medline until September 2006 to identify studies that used specific IT measures in hospitals. The results were mapped and used as a basis for the development of the proposed instrument, which was tested through a survey of Canadian healthcare organizations (N= 221).Results:A total of seventeen studies provided indicators of clinical and administrative IT capacities in hospitals. Based on the mapping of these indicators, a comprehensive IT capacities assessment instrument was developed including thirty-four items exploring computerized processes, thirteen items assessing contemporary technologies, and eleven items investigating internal and external information sharing. A time frame was inserted in the tool to reflect “plans for” versus “current” implementation of IT; in the latter, the extent of current use of computerized processes and technologies was measured on a (1–7) scale. Overall, the survey yielded a total of 106 responses (52.2 percent response rate), and the results demonstrated a good level of reliability and validity of the instrument.Conclusions:This study unifies existing work in this area, and presents the psychometric properties of an IT capacities assessment tool in hospitals. By developing scores for capturing IT capacities in hospitals, it is possible to further address important research questions related to the determinants and impacts of IT sophistication in these settings.
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Menachemi N, Brooks RG, Schwalenstocker E, Simpson L. Use of health information technology by children's hospitals in the United States. Pediatrics 2009; 123 Suppl 2:S80-4. [PMID: 19088234 DOI: 10.1542/peds.2008-1755f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the adoption of health information technology by children's hospitals and to document barriers and priorities as they relate to health information technology adoption. METHODS Primary data of interest were obtained through the use of a survey instrument distributed to the chief information officers of 199 children's hospitals in the United States. Data were collected on current and future use of a variety of clinical health information technology and telemedicine applications, organizational priorities, barriers to use of health information technology, and hospital and chief information officer characteristics. RESULTS Among the 109 responding hospitals (55%), common clinical applications included clinical scheduling (86.2%), transcription (85.3%), and pharmacy (81.9%) and laboratory (80.7%) information. Electronic health records (48.6%), computerized order entry (40.4%), and clinical decision support systems (35.8%) were less common. The most common barriers to health information technology adoption were vendors' inability to deliver products or services to satisfaction (85.4%), lack of staffing resources (82.3%), and difficulty in achieving end-user acceptance (80.2%). The most frequent priority for hospitals was to implement technology to reduce medical errors or to promote safety (72.5%). CONCLUSION This first national look at health information technology use by children's hospitals demonstrates the progress in health information technology adoption, current barriers, and priorities for these institutions. In addition, the findings can serve as important benchmarks for future study in this area.
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Affiliation(s)
- Nir Menachemi
- aDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Chan S. Factors Associated With the Use of Electronic Information Systems for Drug Dispensing and Medication Administration Records in Nursing Homes. J Am Med Dir Assoc 2008; 9:414-21. [DOI: 10.1016/j.jamda.2008.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 02/29/2008] [Accepted: 02/29/2008] [Indexed: 11/28/2022]
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Kilbridge PM, Classen DC. The informatics opportunities at the intersection of patient safety and clinical informatics. J Am Med Inform Assoc 2008; 15:397-407. [PMID: 18436896 PMCID: PMC2442268 DOI: 10.1197/jamia.m2735] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 04/06/2008] [Indexed: 11/10/2022] Open
Abstract
Health care providers have a basic responsibility to protect patients from accidental harm. At the institutional level, creating safe health care organizations necessitates a systematic approach. Effective use of informatics to enhance safety requires the establishment and use of standards for concept definitions and for data exchange, development of acceptable models for knowledge representation, incentives for adoption of electronic health records, support for adverse event detection and reporting, and greater investment in research at the intersection of informatics and patient safety. Leading organizations have demonstrated that health care informatics approaches can improve safety. Nevertheless, significant obstacles today limit optimal application of health informatics to safety within most provider environments. The authors offer a series of recommendations for addressing these challenges.
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Affiliation(s)
- Peter M Kilbridge
- Department of Pediatrics, Washington University School of Medicine, USA.
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Bahensky JA, Jaana M, Ward MM. Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda. J Rural Health 2008; 24:101-5. [DOI: 10.1111/j.1748-0361.2008.00145.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Culler SD, Hawley JN, Naylor V, Rask KJ. Is the availability of hospital IT applications associated with a hospital's risk adjusted incidence rate for patient safety indicators: results from 66 Georgia hospitals. J Med Syst 2007; 31:319-27. [PMID: 17918684 DOI: 10.1007/s10916-007-9071-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines the associations between the availability of IT applications in a hospital and that hospital's risk adjusted incidence rate per 1,000 hospitalizations for Agency for Healthcare Research and Quality's (AHRQ) 15 Patient Safety Indicators (PSIs). The study population consists of a convenience sample of 66 community hospitals in Georgia that completed a Hospital IT survey by December 2003 and provided data to Georgia Hospital Discharge Data Set during 2004. AHRQ's PSI software was used to estimate risk adjusted incidence rates. Differences in means, Pearson correlation coefficients, and multivariate regression analysis were used to determine if the availability of IT applications were associated with better PSI outcomes. This study finds very little statistically significant correlation between the availability of IT applications and risk adjusted PSI incident rate per 1,000
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Affiliation(s)
- Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
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Menachemi N, Hikmet N, Bhattacherjee A, Chukmaitov A, Brooks RG. The effect of payer mix on the adoption of information technologies by hospitals. Health Care Manage Rev 2007; 32:102-10. [PMID: 17438393 DOI: 10.1097/01.hmr.0000267787.71567.3f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Nir Menachemi
- College of Medicine, Florida State University, Tallahassee, FL, USA.
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Sequist TD, Cullen T, Hays H, Taualii MM, Simon SR, Bates DW. Implementation and use of an electronic health record within the Indian Health Service. J Am Med Inform Assoc 2007; 14:191-7. [PMID: 17213495 PMCID: PMC2213460 DOI: 10.1197/jamia.m2234] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 12/11/2006] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans. DESIGN We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005. METHODS The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR. RESULTS The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient-doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05-8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records. CONCLUSIONS Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Abstract
BACKGROUND Outsourcing of information technology (IT) functions is a popular strategy with both potential benefits and risks for hospitals. Anecdotal evidence, based on case studies, suggests that outsourcing may be associated with significant cost savings. However, no generalizable evidence exists to support such assertions. PURPOSE This study examines whether outsourcing IT functions is related to improved financial performance in hospitals. METHODOLOGY Primary survey data on IT outsourcing behavior were combined with secondary data on hospital financial performance. Regression analyses examined the relationship between outsourcing and various measures of financial performance while controlling for bed size, average patient acuity, geographic location, and overall IT adoption. FINDINGS Complete data from a total of 83 Florida hospitals were available for analyses. Findings suggest that the decision to outsource IT functions is not related to any of the hospital financial performance measures that were examined. Specifically, outsourcing of IT functions did not correlate with net inpatient revenue, net patient revenue, hospital expenses, total expenses, cash flow ratio, operating margin, or total margin. PRACTICE IMPLICATIONS In most cases, IT outsourcing is not necessarily a cost-lowering strategy, but instead, a cost-neutral manner in which to accomplish an organizational strategy.
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Ward MM, Jaana M, Bahensky JA, Vartak S, Wakefield DS. Clinical Information System Availability and Use in Urban and Rural Hospitals. J Med Syst 2006; 30:429-38. [PMID: 17233155 DOI: 10.1007/s10916-006-9014-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clinical information systems (CIS) capture clinical data to support more efficient and effective decision making and clinical care delivery. Only a few estimates of CIS availability and use in hospitals are available nationally. The purpose of the current research is to examine differences in CIS availability and use between urban and rural hospitals. A survey addressing this purpose was completed by 74 (63.7%) of Iowa hospitals. Rural hospitals lag behind urban hospitals in terms of many CIS applications. More than 80% of the urban hospitals, but only between 30 and 40% of the rural hospitals, reported using computers to collect basic clinical information for potential use in an electronic medical record (EMR) and computerized provider order entry (CPOE) system. Comparison of CIS within one state's urban and rural hospitals sheds light on variation in clinical support applications, decision support, and electronic medical record "readiness" in these settings.
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Affiliation(s)
- Marcia M Ward
- Department of Health Management and Policy, University of Iowa, 200 Hawkins Dr, E210GH, Iowa City 52242, USA.
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Culler SD, Atherly A, Walczak S, Davis A, Hawley JN, Rask KJ, Naylor V, Thorpe KE. Urban-Rural Differences in the Availability of Hospital Information Technology Applications: A Survey of Georgia Hospitals. J Rural Health 2006; 22:242-7. [PMID: 16824169 DOI: 10.1111/j.1748-0361.2006.00039.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Information technology (IT) has been identified as a potential tool for improving the safety of health care delivery. PURPOSE To determine if there are significant differences between urban and rural community hospitals in the availability of selected IT functional applications and technological devices. METHODS A mailed survey of community hospitals in Georgia assessing the current availability of IT applications (54.6% response rate). FINDINGS Georgia hospitals reported having 63.6% of 56 possible functional applications computerized but only 52.9% of 41 technological devices. Compared to rural hospitals, urban hospitals had significantly more functional applications computerized (38.0 vs 31.8, P = .031) and technological devices available (23.9 vs 18.2, P = .016). Urban hospitals had significantly (P < .05) more IT applications available in 4 areas: emergency room services (7 of 10), surgical/operating room (8 of 12), laboratory (7 of 12), and radiology (5 of 11). Overall, the availability of IT applications was bimodal in rural hospitals: over 40% of rural hospitals had adopted over 70% of all applications, while approximately 26% of rural hospitals had adopted less than 30%. CONCLUSIONS Some of the observed urban/rural differences in availability of IT applications may be due to differences in the scope of services provided by rural hospitals, in particular laboratories, radiology departments, emergency rooms, and surgery/operating rooms. Nevertheless, the bimodal distribution of IT applications adopted in rural hospitals raises concerns about the ability of selected rural hospitals to take advantage of regional data-sharing initiatives and maintain quality of patient care in the future.
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Affiliation(s)
- Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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