A Multi-level Analysis of the Impact of Health Information Technology on Hospital Performance

This paper examines the impact of health information technology (HIT) implementation and meaningful use on hospital productivity and financial performance. Focusing specifically on the healthcare sector allows us to examine at a more granular level the manner in which hospitals and other healthcare organizations adopt, implement and use their HIT systems and how such use impacts their performance. We propose hypotheses predicting a hospital’s operating and financial performance as a function of HIT capital, meaningful use of HIT, and the complementary effect of health information exchange (HIE) coordination with HIT use. Secondary survey data over a three-year period (2008-2010) on various HIT and hospital performance measures collected from 2,557 U.S. hospitals were analyzed by hierarchical linear modeling (HLM) approach. We find reasonably good support for our hypotheses linking HIT capital and meaningful use of HIT to productivity metrics and to financial performance, after controlling for a number of key factors. These findings show that it is important to track and measure meaningful use over and beyond simply looking at HIT adoption statistics.

[1]  M. Shubik,et al.  A Behavioral Theory of the Firm. , 1964 .

[2]  Michael R. Vitale,et al.  Creating Competitive Advantage with Interorganizational Information Systems , 1988, MIS Q..

[3]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[4]  R. Radner The organization of decentralized information processing , 1993 .

[5]  Cynthia Mathis Beath,et al.  The Information Technology Interaction Model: A Foundation for the MBA Core Course , 1995, MIS Q..

[6]  Charles H. Kriebel,et al.  Information Technologies and Business Value: An Analytic and Empirical Investigation , 1995, Inf. Syst. Res..

[7]  R. Bosker Boekbespreking van "A.S. Bryk & S.W. Raudenbusch - Hierarchical linear models: Applications and data analysis methods" : Sage Publications, Newbury Parki, London/New Delhi 1992 , 1995 .

[8]  E. Brynjolfsson,et al.  Paradox Lost? Firm-Level Evidence on the Returns to Information Systems Spending , 1996 .

[9]  T. C. Powell,et al.  Information technology as competitive advantage: the role of human , 1997 .

[10]  Judith D. Singer,et al.  Using SAS PROC MIXED to Fit Multilevel Models, Hierarchical Models, and Individual Growth Models , 1998 .

[11]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[12]  Sundar G. Bharadwaj,et al.  Information Technology Effects on Firm Performance as Measured by Tobin's q , 1999 .

[13]  K. Davis Common Concerns: International Issues in Health Care System Reform , 1999 .

[14]  Anandhi S. Bharadwaj,et al.  A Resource-Based Perspective on Information Technology Capability and Firm Performance: An Empirical Investigation , 2000, MIS Q..

[15]  Rajiv Kohli,et al.  Information Technology Payoff in the Health-Care Industry: A Longitudinal Study , 2000, J. Manag. Inf. Syst..

[16]  E. Brynjolfsson,et al.  Beyond Computation: Information Technology, Organizational Transformation and Business Performance , 2000 .

[17]  Nirup M. Menon,et al.  Productivity of Information Systems in the Healthcare Industry , 2000, Inf. Syst. Res..

[18]  Lorin M. Hitt,et al.  Do Better Customers Utilize Electronic Distribution Channels? The Case of PC Banking , 2002, Manag. Sci..

[19]  Rajiv Kohli,et al.  Performance Impacts of Information Technology: Is Actual Usage the Missing Link? , 2003, Manag. Sci..

[20]  Kenneth L. Kraemer,et al.  Information technology and economic performance , 2003, ACM Comput. Surv..

[21]  E. Brynjolfsson,et al.  Computing Productivity: Firm-Level Evidence , 2003, Review of Economics and Statistics.

[22]  Kenneth L. Kraemer,et al.  Review: Information Technology and Organizational Performance: An Integrative Model of IT Business Value , 2004, MIS Q..

[23]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[24]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005, JAMA.

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

[26]  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.

[27]  Rainu Kaushal,et al.  Technology Evaluation: Return on Investment for a Computerized Physician Order Entry System , 2006, J. Am. Medical Informatics Assoc..

[28]  Matthew H Samore,et al.  Developing Indicators of Inpatient Adverse Drug Events Through Nonlinear Analysis Using Administrative Data , 2007, Medical care.

[29]  Sinan Aral,et al.  I.T. Assets, Organizational Capabilities and Firm Performance: Do Resource Allocations and Organizational Differences Explain Performance Variation? , 2007 .

[30]  Donald R. Jones,et al.  Refining the IT Business Value Model: Evidence From a Longitudinal Investigation of Healthcare Firms , 2008, ICIS.

[31]  Yasar A Ozcan,et al.  Do Hospitals With Electronic Medical Records (EMRs) Provide Higher Quality Care? , 2008, Medical care research and review : MCRR.

[32]  N. Menachemi,et al.  Hospital quality of care: Does information technology matter? The relationship between information technology adoption and quality of care , 2008, Health care management review.

[33]  N. Powe,et al.  Clinical information technologies and inpatient outcomes: a multiple hospital study. , 2009, Archives of internal medicine.

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

[35]  Pascale Carayon,et al.  From tasks to processes: the case for changing health information technology to improve health care. , 2009, Health affairs.

[36]  Nirup M. Menon,et al.  Differential Effects of the Two Types of Information Systems: A Hospital-Based Study , 2009, J. Manag. Inf. Syst..

[37]  Catherine Tucker,et al.  Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records , 2009, Manag. Sci..

[38]  Jeffrey S McCullough,et al.  Health information technology and patient safety: evidence from panel data. , 2009, Health affairs.

[39]  Ron Borzekowski Measuring the Cost Impact of Hospital Information Systems: 1987-1994 , 2002, Journal of health economics.

[40]  Blackford Middleton,et al.  The value from investments in health information technology at the U.S. Department of Veterans Affairs. , 2010, Health affairs.

[41]  Charles P Friedman,et al.  Alternative measures of electronic health record adoption among hospitals. , 2010, The American journal of managed care.

[42]  C. DesRoches,et al.  A progress report on electronic health records in U.S. hospitals. , 2010, Health affairs.

[43]  Joshua R. Vest,et al.  What should we measure? Conceptualizing usage in health information exchange , 2010, J. Am. Medical Informatics Assoc..

[44]  T. S. Raghu,et al.  Electronic Medical Records and Cost Efficiency in Hospital Medical-Surgical Units , 2010, Inquiry : a journal of medical care organization, provision and financing.

[45]  Vallabh Sambamurthy,et al.  Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in U.S. Hospitals , 2010, Manag. Sci..

[46]  Paul Heaton,et al.  Today's 'meaningful use' standard for medication orders by hospitals may save few lives; later stages may do more. , 2011, Health affairs.

[47]  Maulik S Joshi,et al.  Progress toward meaningful use: hospitals' adoption of electronic health records. , 2011, The American journal of managed care.

[48]  Sarv Devaraj,et al.  Performance Effects Related to the Sequence of Integration of Healthcare Technologies , 2011 .

[49]  Robert H. Miller,et al.  Satisfying patient-consumer principles for health information exchange: evidence from California case studies. , 2012, Health affairs.

[50]  Erik Brynjolfsson,et al.  Three-Way Complementarities: Performance Pay, Human Resource Analytics, and Information Technology , 2012, Manag. Sci..

[51]  Prasanna Tambe,et al.  The Productivity of Information Technology Investments: New Evidence from IT Labor Data , 2011, Inf. Syst. Res..

[52]  Christina Zimmerman The effect of health information technology on quality in U.S. hospitals. , 2012, Findings brief : health care financing & organization.

[53]  C. DesRoches,et al.  Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. , 2012, Health affairs.

[54]  H. Greve Behavioral Theory of the Firm , 2013 .