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Environmental market factors associated with electronic health record adoption among cancer hospitals

Tarver, Will L.; Menachemi, Nir

doi: 10.1097/HMR.0000000000000149
Features

Background: Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care.

Purpose: The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals.

Methods/Approach: Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited.

Findings: In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals.

Practice implications: A greater understanding of the environment’s relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities’ respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.

Will L. Tarver, DrPH, MLIS, is Postdoctoral Fellow, Training in Research for Behavioral Oncology and Cancer Control Program, Indiana University, and Postdoctoral Fellow, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana. E-mail: wltarver@iu.edu.

Nir Menachemi, PhD, MPH, is Professor and Chair, Health Policy and Management, Fairbanks School of Public Health, Indiana University, and Affiliated Scientist, Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana.

This work was supported by the National Cancer Institute Cancer Prevention and Control Training Program Grant R25 CA04788.

Institutional review board approval was received from the University of Alabama at Birmingham’s Human Subjects Committee.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Institutional review board approval was received from the University of Alabama at Birmingham’s Human Subjects Committee.

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