22 Chapter 2 INTRODUCTION The EMR has emerged as a very significant component of the health information technology landscape. 1 EMRs are “systems that integrate electronically originated and maintained patient-level clinical information, derived from multiple sources, into one point of access and replaces the paper medical record as the primary source of patient information.” 2 EMRs are expected to drastically change healthcare by making care more efficient while also improving quality through the automation of care and the more complete documentation and dissemination of individual medical records. 3 However, the implementation and use of EMRs in acute care hospitals has been slow. 4 The barriers to EMR adoption are varied and include cost, concerns regarding information security, and physician resistance. 5 Although there has been discussion of widespread EMR use for several years, a national interoperable EMR system in The Netherlands (NL) has yet to emerge. A national interoperable EMR system would allow patients, payers, and providers to document and widely share health information for individuals quickly using computers, but would require a standardized format, confidentiality regulations, nearly unanimous support, and a large financial investment. 6 While this type of a system does not yet exist, several NL healthcare providers have already implemented EMRs and reported their experiences. While the overall adoption of EMRs has been slow, it has not been completely stagnant. Purpose and research question Given that IT is assumed to be fundamental to an organization’s survival and growth, they face the critical challenge of integrating, building, and reconfiguring IT resources so as to obtain competitive advantage and superior performance. Recently, a number of researchers 7–10 have applied resource based view and resource dependence theory to investigating IT business value, with mixed results. One major research stream explores the relationships between IT and environmental issues. Another major stream explores the relationships between IT and other organizational factors (i.e., organizational strategy, organizational process, organizational culture, organizational structure). A third major stream explores the relationships between IT and methods of organizing IT resources to align themwith enterprises. However, at present, we know very little about these relationships in hospitals. The purpose of this study is to identify organizational and environmental factors that are associated with the adoption and use of hospital EMRs. The results of this study may guide policy and practice by identifying specific barriers to hospital EMR use.
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