108 Chapter 8 This chapter encompasses the conclusions and implications of the findings in the previous chapters. It discusses themain findings, it summarizes the answer to the central research question, the scientific and policy relevance of the thesis and the strengths and weaknesses of the research. The perspective of the results for the digitization of hospitals in the Netherlands and beyond are also discussed and in addition recommendations for practice. Finally, directions for further research are explored. INTRODUCTION This thesis had the objective to contribute to the scientific discourse on ‘the relationship between the digitization of hospital information and processes and the effect on the quality of care’. This aim was translated into the central research question: What is the relationship between the maturity of hospital information systems and the quality of care? This question can be divided into three sub-questions: • How mature are the information systems of the Dutch hospitals and what are the influencing factors (determinants) for this degree of maturity? • What is the association between the degree of maturity of information systems of hospitals and the quality of care? • Which positive or negative aspects influence the relationship between EMR use and the quality of medical care according to medical specialists? MAIN FINDINGS Subquestion 1. How mature are the information systems of the Dutch hospitals and what are the influencing factors (determinants) for this degree of maturity – main findings chapter 2. Of the 93 hospitals (2012-2014) in the Netherlands, 72 hospitals were measured, of which some hospitals repeatedly (three times) for the several underlying studies. Of the eight University Medical Centers, six participated. For the top clinical hospitals, 27 of the 30 participated. It was noticeable that the smaller general hospitals, in particular, did participate less (19 of 31). We found that for about 40% (28) of the 73 hospitals, clinical documentation, especially nursing documentation was a challenge. Nine hospitals
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