Li Pengxiang, Bahensky James A, Jaana Mirou, Ward Marcia M
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, USA.
Health Care Manage Rev. 2008 Apr-Jun;33(2):169-77. doi: 10.1097/01.HMR.0000304502.20179.32.
Health information technology (HIT) is designed to help reduce medical errors and improve quality of care and efficiency by providing the right information for the right patients in the right place at the right time. Nevertheless, substantial variation currently exists in the adoption of electronic medical records (EMRs) resulting in differences in hospital HIT capacity.
The purpose of this article is to examine the impact of different types of multihospital system affiliation on EMR adoption in hospitals in the United States.
A cross-sectional design was used with a sample of 4,017 hospitals in the United States. Secondary data were retrieved from the Health Information and Management Systems Society Analytics Database. Multiple regression analysis was used to examine the impact of multihospital system affiliation on EMR level of adoption.
The mean EMR adoption level varies significantly between independent hospitals and hospitals owned by a system for small hospitals. After adjusting for the number of operating rooms, the number of emergency room visits, and the number of hospital total full-time equivalent staff, small hospitals owned by multihospital systems were associated with 0.25 higher mean EMR adoption level (p < .05) than independent hospitals and no significant relationship was observed for hospitals that were leased/managed by a system. There was no significant effect of multihospital system membership on EMR level of adoption for medium and large hospitals.
Small hospitals owned by multihospital systems had a significantly higher EMR level compared with independent hospitals. These findings have significant implications for small hospitals that are struggling to improve their HIT capacity. Smaller hospitals in ownership arrangements with larger health care systems have an advantage over small independent hospitals in HIT capacity possibly because of the greater availability of capital, access to shared HIT capacity, and other resources including technical expertise.
健康信息技术（HIT）旨在通过在正确的时间、为正确的患者、在正确的地点提供正确的信息，帮助减少医疗差错，提高医疗质量和效率。然而，目前电子病历（EMR）的采用情况存在很大差异，导致医院的HIT能力有所不同。
本文旨在研究不同类型的多医院系统附属关系对美国医院电子病历采用情况的影响。
采用横断面设计，样本为美国的4017家医院。二级数据从健康信息与管理系统协会分析数据库中检索。多元回归分析用于检验多医院系统附属关系对电子病历采用水平的影响。
独立医院和小型医院系统所属医院之间的电子病历平均采用水平存在显著差异。在调整手术室数量、急诊就诊次数和医院全职等效员工总数后，多医院系统所属的小型医院的电子病历平均采用水平比独立医院高0.25（p <.05），而系统租赁/管理的医院未观察到显著关系。多医院系统成员资格对中型和大型医院的电子病历采用水平没有显著影响。
与独立医院相比，多医院系统所属的小型医院的电子病历水平显著更高。这些发现对正在努力提高其HIT能力的小型医院具有重要意义。与大型医疗系统有所有权安排的小型医院在HIT能力方面比小型独立医院具有优势，这可能是因为有更多的资金可用、能够共享HIT能力以及其他资源，包括技术专长。
