Financial position and adoption of electronic health records: a retrospective longitudinal study.

AIM Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. METHODS Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. RESULTS For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. CONCLUSIONS Financial position does relate to EHR adoption in mid-term and long-term planning.

[1]  Thomas T H Wan,et al.  Factors Influencing Health Information System Adoption in American Hospitals , 2005, Health care management review.

[2]  Jill R Horwitz,et al.  U.S. adoption of computerized physician order entry systems. , 2005, Health affairs.

[3]  David W. Bates,et al.  Position Paper: Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion , 2004, J. Am. Medical Informatics Assoc..

[4]  J. McCullough,et al.  The effect of health information technology on quality in U.S. hospitals. , 2010, Health affairs.

[5]  Yasar A. Ozcan,et al.  Organizational and Environmental Determinants of Hospital EMR Adoption: A National Study , 2007, Journal of Medical Systems.

[6]  S. Shortell,et al.  Top manager and network effects on the adoption of innovative management practices: a study of TQM in a public hospital system , 2001 .

[7]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[8]  R. Steinbrook.  Health care and the American Recovery and Reinvestment Act. , 2009, The New England journal of medicine.

[9]  Nir Menachemi,et al.  Hospital IT Adoption Strategies Associated with Implementation Success: Implications for Achieving Meaningful Use , 2010, Journal of healthcare management / American College of Healthcare Executives.

[10]  Richard Williams.  Generalized Ordered Logit/Partial Proportional Odds Models for Ordinal Dependent Variables , 2006 .

[11]  W. Manning,et al.  The effects of group size and group economic factors on collaboration: a study of the financial performance of rural hospitals in consortia. , 1999, Health services research.

[12]  Robin C. Meili,et al.  Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. , 2005, Health affairs.

[13]  L. C. Gapenski.  Healthcare Finance: An Introduction to Accounting and Financial Management , 2001 .

[14]  N. Menachemi,et al.  Hospital Information Technology and Positive Financial Performance: A Different Approach to Finding an ROI , 2006, Journal of healthcare management / American College of Healthcare Executives.

[15]  Jay J. Shen,et al.  Hospital Financial Position and the Adoption of Electronic Health Records , 2011, Journal of healthcare management / American College of Healthcare Executives.