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The American Journal of Managed Care January 2019
The Gamification of Healthcare: Emergence of the Digital Practitioner?
Eli G. Phillips Jr, PharmD, JD; Chadi Nabhan, MD, MBA; and Bruce A. Feinberg, DO
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Rajesh Balkrishnan, PhD
The Health Information Technology Special Issue: New Real-World Evidence and Practical Lessons
Mary E. Reed, DrPH
Inpatient Electronic Health Record Maintenance From 2010 to 2015
Vincent X. Liu, MD, MS; Nimah Haq, MPH; Ignatius C. Chan, MD; and Brian Hoberman, MD, MBA
Impact of Primary and Specialty Care Integration via Asynchronous Communication
Eric D. Newman, MD; Paul F. Simonelli, MD, PhD; Shelly M. Vezendy, BS; Chelsea M. Cedeno, BS; and Daniel D. Maeng, PhD
Mind the Gap: The Potential of Alternative Health Information Exchange
Jordan Everson, PhD; and Dori A. Cross, PhD
Patient and Clinician Experiences With Telehealth for Patient Follow-up Care
Karen Donelan, ScD, EdM; Esteban A. Barreto, MA; Sarah Sossong, MPH; Carie Michael, SM; Juan J. Estrada, MSc, MBA; Adam B. Cohen, MD; Janet Wozniak, MD; and Lee H. Schwamm, MD
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Sung J. Choi, PhD; and M. Eric Johnson, PhD
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Organizational Influences on Healthcare System Adoption and Use of Advanced Health Information Technology Capabilities
Paul T. Norton, MPH, MBA; Hector P. Rodriguez, PhD, MPH; Stephen M. Shortell, PhD, MPH, MBA; and Valerie A. Lewis, PhD, MA
Drivers of Health Information Exchange Use During Postacute Care Transitions
Dori A. Cross, PhD; Jeffrey S. McCullough, PhD; and Julia Adler-Milstein, PhD

Organizational Influences on Healthcare System Adoption and Use of Advanced Health Information Technology Capabilities

Paul T. Norton, MPH, MBA; Hector P. Rodriguez, PhD, MPH; Stephen M. Shortell, PhD, MPH, MBA; and Valerie A. Lewis, PhD, MA
This is the first national study to examine the relationship between healthcare system organizational characteristics and adoption of advanced health information technology capabilities.
ABSTRACT

Objectives: The adoption of advanced health information technology (HIT) capabilities, such as predictive analytic functions and patient access to records, remains variable among healthcare systems across the United States. This study is the first to identify characteristics that may drive this variability among health systems.

Study Design: Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record (EHR) standardization, and resource allocation practices were associated with use of 5 advanced HIT capabilities. Of 732 systems surveyed, 446 responded (60.9%), 425 (58.1%) met sample inclusion criteria, and 389 (53.1%) reported consistent EHR use.

Methods: Measures of adoption, resource allocation, and organizational structure were developed based on survey responses. Multivariate linear regression with control variables estimated the relationships.

Results: Adoption of advanced HIT capabilities is low and variable, with a mean of 2.4 capabilities adopted and only 8.4% of systems reporting widespread adoption of all 5 capabilities. In adjusted analyses, EHR standardization (β = 0.76; P = .001) was the strongest predictor of the number of advanced capabilities adopted, and ownership and management of medical groups (β = 0.32; P = .04) was also a significant predictor.

Conclusions: Health systems that standardize their EHRs and that own and manage hospitals and medical groups have higher rates of advanced HIT adoption and use. System leaders looking to increase the use of advanced HIT capabilities should consider ways to better standardize their EHRs across organizations.

Am J Manag Care. 2019;25(1):e21-e25
Takeaway Points

The adoption of advanced health information technology (HIT) capabilities, such as predictive analytic functions and patient access to records, varies among healthcare systems across the United States. This study is the first to identify characteristics that may drive this variability among health systems.
  • Multivariate regression analysis was used to determine the extent to which organizational structure, resource allocation practices, and electronic health record (EHR) standardization predicted HIT adoption.
  • EHR standardization was the strongest predictor of advanced HIT adoption. Owning and managing medical groups and hospitals was also a statistically significant predictor of advanced HIT adoption.
  • Health system leaders looking to improve the rates of advanced technology adoption may consider ways to standardize their EHR systems across organizations.
Since the passage of the Patient Protection and Affordable Care Act in 2010, health systems, hospitals, and medical groups have faced considerable public pressure1 to assume an increased amount of risk for the costs and outcomes of their patient populations through value-based payment models. This increased risk requires transforming the way that healthcare services are delivered and reimagining the role that health systems play in managing their patient populations. One response has been the development of more than 1000 accountable care organizations (ACOs) in the 50 states, providing care to nearly 33 million Americans.2 A key capability of such organizations is their use of advanced health information technology (HIT),3 but adoption of HIT capabilities necessary to enable value-based care remains slow.4 Although vendors have developed a wider variety of additional capabilities to facilitate patient engagement and performance measurement, wide variability in the uptake of these features by healthcare organizations has caused increasing concerns about a “digital advanced use divide.”5

Given the extensive and well-documented challenges that come with driving innovations in health systems,6 it seems likely that at least some of this variation can be explained by organizational characteristics. Previous studies in medical groups, for example, have found hospital ownership to be predictive of basic HIT adoption and care management processes in medical groups,7,8 and others have found that larger, more integrated ACOs are better positioned for technology adoption.9 These findings generate further questions regarding the heterogeneity of HIT implementation among health systems, such as how they allocate resources for HIT development and the extent to which they standardize their use of HIT.

There is considerable heterogeneity in organizational models used by health systems. In this study, health systems were defined as corporate parents or owner subsidiaries that include either 1 hospital and at least 1 set of primary care physicians, 2 or more hospitals, or 2 or more primary care groups and are connected by contract or ownership. Systems may own and manage hospitals and medical practices associated with the system or may operate under affiliate models. It is possible that health systems with more direct management responsibilities of their hospitals and medical groups may more effectively integrate different stakeholders, a critical element of innovation in healthcare organizations,10 and may be able to deliver more training across the enterprise, another critical success factor of electronic health record (EHR) implementations identified in previous research.11

Second, resource allocation practices can vary widely across health systems. Health systems that centrally allocate resources and purchase software may realize economies of scale with their purchases and have more bargaining power with vendors, which would enable greater adoption of advanced capabilities. In addition, they may have greater resources to invest in enterprise-wide training. Existing research provides some empirical evidence of the impact of resources on HIT adoption in health systems,9 and there is also evidence that information technology (IT) resources have driven adoption and success of other types of software systems in large enterprises.12

Finally, there may be differences in the extent to which health systems standardize their use of technology. Health systems that standardize their EHRs will likely need to change fewer processes and deliver fewer different versions of training when rolling out new capabilities, which may enable greater adoption. Although the link between enterprise-wide technology standardization and adoption has not been empirically examined in health systems, researchers have documented the importance of enterprise-wide architecture and standards for other IT capabilities within large organizations.13

Drawing on the conceptual model shown in the Figure, the following 3 hypotheses were tested: (1) Compared with health systems that do not own and manage medical groups and hospitals, health systems that own and manage medical groups and hospitals will have greater adoption of advanced HIT capabilities; (2) Compared with health systems with decentralized resource allocation practices, health systems with more centralized resource allocation practices will have greater adoption of advanced HIT capabilities; and (3) Compared with health systems with low EHR standardization, health systems with higher degrees of EHR standardization will have greater adoption of advanced HIT capabilities.


 
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