Department of Health Administration, PO Box 980203, Virginia Commonwealth University, Richmond, USA.
Health Care Manage Rev. 2012 Jan-Mar;37(1):4-13. doi: 10.1097/HMR.0b013e318239f2ff.
Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance.
This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses.
A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics.
The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy.
This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward an enterprise application strategy.
电子病历（EMR）系统的成功实施和受益能力可能与管理员在获取 EMR 系统时选择的企业应用程序策略类型相关。此外，确定最优化的企业应用程序策略可能与医院绩效有重要联系。
本研究探讨了采用差异化 EMR 企业应用程序策略的医院在整体效率上是否存在差异。具体而言，研究考察了采用单一供应商策略的医院是否比采用最佳组合策略的医院更有可能具有效率，以及采用最佳套件策略的医院是否比采用最佳组合或单一供应商策略的医院更有可能具有效率。采用概念框架来制定可测试的假设。
采用回顾性横截面方法，使用数据包络分析获取按 EMR 企业应用程序策略分类的医院效率得分。然后，使用 Tobit 回归分析确定与医院 EMR 企业应用程序策略相关的医院无效率的概率，同时为医院的 EMR“实施状态”进行调节，并控制医院和市场特征。
对医院的数据包络分析表明，在研究的 2171 家医院样本中，只有 32 家医院是有效的。事后分析的结果部分支持这样的假设，即采用最佳套件策略的医院比采用单一供应商策略的医院更有可能具有效率。
本研究强调了理解本文讨论的三种策略之间差异的重要性。基于研究结果，医院管理人员在选择企业应用程序策略之前，应考虑特定策略与其他策略相比可能具有的效率关联。
