20 Chapter 2 ABSTRACT Background Much research has been conducted on the organizational and environmental factors associated with the adoption and use of electronic medical records (EMRs) in hospitals. With much of these studies focused on U.S. hospitals, there are limited studies at this time surrounding the adoption of EMRs in Dutch hospitals. The purpose of this study is to profile the organizational and environmental factors associated with the adoption and use of EMR technologies in Dutch hospitals. Methods Using the HIMSS Analytics Electronic Medical Record Adoption Model to define a hospital’s EMR capabilities, acute care hospitals in the Netherlands (NL) were surveyed regarding their EMR capabilities. From this data, we determined the proportion of hospitals that had a comprehensive EMR system in use in various clinical areas of the hospital and then examined the relationship between the hospital’s EMR capabilities and various intervening variables to include environmental factors, hospital characteristics and information and communications technology (ICT) characteristics. Results The results of this study indicate that Dutch hospitals reflect a varied array of EMR capabilities. Of the 72 hospitals surveyed between 2012 and 2014 (77.4% of all NL hospitals), 15.3% had a comprehensive EMR system present in at least one clinical unit. The findings also revealed notable EMR capability differences by organizational and environmental characteristics. Larger hospitals and academic affiliated hospitals were more likely to have advanced EMR systems. There also appears to be a positive association between EMR capabilities and the size of a hospital’s IT budget. Conclusions The findings of this research project support studies from the U.S. that hospital organizational and environmental factors are associated with the adoption and use of EMR technologies. The findings generally supported half of the hypotheses forwarded in the study design. There was no support for example for the hypothesis that EMR capabilities in the Netherlands are positively associated with hospital competition and population density. This latter finding suggests the need for subsequent research studies surrounding a ‘leadership and culture’ hypothesis.
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