23 Profile of the digitization of patient medical records in Dutch hospitals Theoretical model For this study we used the Resource dependence theory model. This theory begins with the premise that organizations are not in control of all of the resources they need to survive. As such, many of the organization’s strategies for survival include attempts to reduce their dependence on external resources in times of uncertainty by securing necessary inputs. Moreover, Iroju O., et al 6 claim that the omnipresence of information and communications technology (ICT) makes information about quality and prices more readily available, generally lowering dependence among buyers and suppliers able to develop alternatives more readily. This may disturb the power balance. We elected to apply the Resource Dependence Theory to the adoption of hospital EMRs because this theory allows us to develop a fairly comprehensive model 11 (see Figure 1) to identify significant predictors and barriers to EMR use. Hypotheses to test According to the Resource Dependence theory, environmental uncertainty may motivate organizational action or strategy. 12 Organizations in areas of greater uncertainty aremore likely to take action to secure resources than organizations in areas of less uncertainty. After all, organizations with certain access to necessary resources do not need to secure inputs from the environment, while organizations in uncertain environments must adapt to their surroundings in order to survive. Since EMRs may lead to better hospital performance and outcomes as well as increasing efficiency, some hospitals may use EMRs as a strategy to combat this environmental uncertainty. From this model we deducted the following hypotheses. H1: Hospitals in a lower population density area are less likely to have advanced EMR capabilities. As hospitals are scarcer in areas of lower population areas, (potential) patients have less choice and hospitals have less urgency to adopt advanced technologies like EMRs As hospitals are scarcer in areas of lower population areas, (potential) patients have less choice and hospitals have less urgency to adopt advanced technologies like EMRs. H2: As environmental competition increases, the likelihood of having advanced EMR capabilities increases. The level of competition in an external environment, according to Resource Dependency theory, is a large predictor of organizational strategy and action. In an area with a great deal of competition, hospitals must compete for the same resources, thus making inputs 2
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