College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States.
JMIR Med Inform. 2014 May 23;2(1):e9. doi: 10.2196/medinform.3106.
The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated $19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR.
The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector.
We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE). We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption.
The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used in articles, editorials, books, as well as quantitative and qualitative studies (n=83). As of 2009, only 16.30% (815/4999) of nonfederal, acute-care hospitals had adopted a fully interoperable EHR. From the 83 articles reviewed in this study, 16/83 (19%) identified internal organizational factors and 9/83 (11%) identified external environmental factors associated with adoption of the EHR, EMR, or CPOE. The conceptual model for EHR adoption associates each variable with the work that identified it.
Commonalities exist in the literature for internal organizational and external environmental factors associated with the adoption of the EHR and/or CPOE. The conceptual model for EHR adoption associates internal and external factors, specific to the health care industry, associated with adoption of the EHR. It becomes apparent that these factors have some level of association, but the association is not consistently calculated individually or in combination. To better understand effective adoption strategies, empirical studies should be performed from this conceptual model to quantify the positive or negative effect of each factor.
《健康信息技术经济与临床健康法案》（HITECH）拨款 192 亿美元激励电子病历（EHR）的采用。自 2009 年以来，有意义的使用标准一直主导着信息技术（IT）战略。医疗机构一直在努力满足期望并避免医疗保险和医疗补助服务中心（CMS）的报销罚款。组织理论试图解释影响组织变革的因素，许多理论都涉及组织战略的变化。然而，由于医疗保健行业的复杂性，现有的组织理论未能证明与重要的医疗保健 IT 实施之间存在关联。没有针对医疗保健的组织理论可以识别、分组和分析与大型医疗保健 IT 实施（如采用 EHR）相关的内部和外部影响因素。
本系统评价的目的是确定与健康信息学（HIT），特别是电子病历（EHR）的采用相关的内部组织和外部环境因素的全谱。结果是一个概念模型，与医疗保健部门的复杂性相匹配。
我们在 PubMed（仅限英语）、EBSCO 主机和 Google Scholar 中进行了系统的文献检索，检索了 1993 年至 2013 年期间的实证研究和基于理论的论文，这些研究表明了有影响力的因素与三种 HIT 模式之间的关联：EHR、电子病历（EMR）和计算机化医嘱录入（CPOE）。我们还查看了有关组织理论的出版书籍。我们对采用因素进行了注释和趋势分析。这些因素被分为与各种版本的 EHR 采用相关的采用因素。
由此产生的概念模型总结了在文章、社论、书籍以及定量和定性研究中使用的独立变量（IV）和因变量（DV）的多样性（n=83）。截至 2009 年，只有 16.30%（815/4999）的非联邦急症医院采用了完全互操作的 EHR。在这项研究中审查的 83 篇文章中，有 16/83（19%）确定了与采用 EHR、EMR 或 CPOE 相关的内部组织因素，有 9/83（11%）确定了与采用 EHR 相关的外部环境因素。EHR 采用的概念模型将每个变量与确定它的工作联系起来。
文献中存在与采用 EHR 和/或 CPOE 相关的内部组织和外部环境因素的共同点。EHR 采用的概念模型将与医疗保健行业相关的内部和外部因素与 EHR 的采用联系起来。显然，这些因素存在某种程度的关联，但关联并没有单独或组合进行一致计算。为了更好地理解有效的采用策略，应从这个概念模型中进行实证研究，以量化每个因素的积极或消极影响。
