13 Introduction outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable, and people-centered” 12. Central to the definition is the provision of health care by the health care provider to the individual patient or client. Quality monitoring 13 is becoming an accepted method for insurers, patients, and providers to evaluate the value of health care expenditures. Significant advances in the science of quality measurement have occurred over the past decade. Still, many challenges remain to be addressed so that quality monitoring may realize its potential as a counterforce to the demands of cost containment. In the next paragraph the quality and safety measures as used in this thesis are explained in more detail. Objective and outline of the thesis. This thesis has 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 is translated into the central research question: What is the relationship between the maturity of hospital information systems and the quality of care? This question is divided into three sub-questions: 1. How mature are the information systems of the Dutch hospitals and what are the influencing factors (determinants) for this degree of maturity? 2. What is the association between the degree of maturity of information systems of hospitals and the quality of care? 3. Which positive or negative aspects influence the relationship between EMR use and the quality of medical care according to medical specialists? The purpose of the first subquestion is to identify organizational and environmental factors that are associated with the adoption and use of hospital EMRs as determined using the EMRAM model as described (see chapter 2). The second subquestion (chapter 3, 4, 5) concerns the effects of the degree of maturity and its consequences for the quality of care. Relevant is to investigate the link between the EMRAM-score and the quality of care. The maturity concept assumes that this relationship exists in a positive sense: a higher score also translates to a higher level of 1
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