Harvard Business School, Boston, Massachusetts, USA.
Harvard T.H. Chan School of Public Health, Harvard Global Health Institute, Cambridge, Massachusetts, USA.
Health Serv Res. 2022 Apr;57(2):259-269. doi: 10.1111/1475-6773.13655. Epub 2021 Mar 29.
To identify organizational complementarities of adoption and use of electronic health records (EHRs) and assess what organizational strategies were associated with more advanced EHR use.
Primary survey data of US hospitals combined with secondary data from the American Hospital Association Annual Survey and IT Supplement.
In this cross-sectional study, we describe hospital organizational practices around EHR adoption and use and identify how these practices coalesce into distinct strategies. We then assess the association between those organizational strategies and adoption of advanced EHR functions.
Primary data collection consisted of surveys sent to 797 US acute care hospitals in 2018-2019, with 451 complete respondents.
There was significant variation in hospital organizational practices for EHR adoption and use. Factor analysis identified practices in three domains: leadership engagement, human capital, and systems integration. Hospitals in the top quartile of the leadership engagement factor were 14 percentage points more likely to have adopted patient engagement EHR functions (P = 0.01) while hospitals in the top quartile of human capital were 14 percentage points less likely to have adopted these functions (P = 0.02). Hospitals in the top quartile of systems integration were 12 percentage points more likely to have adopted patient engagement functions (P = 0.02) and 14 percentage points more likely to have adopted EHR data analytics functions (P = 0.02).
Our findings suggest that specific organizational strategies are associated with more advanced EHR adoption. Hospital leaders interested in realizing more value from their EHR investment may find it useful to know that there is an association between adoption of more advanced EHR functions, and engaging senior leadership as well as building connectivity between clinical and administrative systems.
确定电子病历（EHR）采用和使用的组织互补性，并评估哪些组织策略与更先进的 EHR 使用相关。
美国医院的主要调查数据与美国医院协会年度调查和 IT 补充调查的次要数据相结合。
在这项横断面研究中，我们描述了围绕 EHR 采用和使用的医院组织实践，并确定了这些实践如何融合成不同的策略。然后，我们评估了这些组织策略与先进的 EHR 功能采用之间的关联。
主要数据收集包括 2018-2019 年向 797 家美国急症护理医院发送的调查，共有 451 家完整回复。
医院在 EHR 采用和使用方面的组织实践存在显著差异。因素分析确定了三个领域的实践：领导力参与、人力资本和系统集成。领导力参与因素排名前四分之一的医院采用患者参与 EHR 功能的可能性高出 14 个百分点（P=0.01），而人力资本排名前四分之一的医院采用这些功能的可能性低 14 个百分点（P=0.02）。系统集成排名前四分之一的医院采用患者参与功能的可能性高出 12 个百分点（P=0.02），采用 EHR 数据分析功能的可能性高出 14 个百分点（P=0.02）。
我们的研究结果表明，特定的组织策略与更先进的 EHR 采用相关。对从 EHR 投资中获得更多价值感兴趣的医院领导者可能会发现，了解更先进的 EHR 功能的采用与高级领导的参与以及临床和行政系统之间的连接之间存在关联是有用的。
