25 Profile of the digitization of patient medical records in Dutch hospitals FEATURE: PROFILE OF THE DIGITIZATION 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 potentially scarcer and placing hospitals under more pressure to distinguish themselves from competitors, thus securing their market share of patients. If patients have more choices, they may elect where to go for healthcare andwill likely choose a hospital that offers new or better services such as EMRs. Hospitals may reason that EMRs will make themmore appealing to the patient population in an area of high competitionwhere patients have choices of where to receive care. In the Netherlands the bargaining of hospital services is done exclusively by the healthcare insurance companies. In some areas certain healthcare insurance companies have a prevalent position. H3: Larger hospitals are more likely to have advanced EMR capabilities. Perhaps the greatest barrier to hospital EMR adoption is the cost of implementation and maintenance. With adequate financial resources, hospitals are likely more able to purchase the often-expensive EMR systems and equipment. However, not all hospitals have the financial means to implement anduse completeEMRsystems. Those with smaller operating margins are less likely to have the funds to buy and implement EMRs. Organizational power is often associated with organizational FIGURE 1: Comparable model (also used by Kazley, A.S.; Ozcan, Y.A., Organizational and environmental determinants of hospital EMR adoption: a national study)11 ENVIRONMENTAL FACTORS n■ Population density n■ Competition ICT FACTORS n■ ICT budget n■ Number of ICT employees ORGANIZATIONAL FACTORS n■ Financial resources n■ Hospital size n■ Teaching status n■ Leadership and culture? EMR ADOPTION AND USE? Figure 1: Comparabl m del (also used by Kazley, A.S.; Ozcan, Y.A., Organizational and environ ental determinants of hospital EMR adoption: a nat onal study 11) H5: Hospi als with rel tively higher ICT budgets t nd to hav more advanced EMR capabilities. EMR implementation requires several tens of millions of euro’s budget over the years to bring result to success. ICT budgets typically fall in the range from 2% to 10% of a hospital’s total expenditure. It is to be expected that the higher the structural budget the better the EMR adoption. H6: Hospitals with relatively more ICT employees tend to have more advanced EMR capabilities. The successful implementation of EMR systems needs a broad range of expertise to include information architects, project managers, infrastructure specialists, and maintenance specialists. We expect that having more and better resources lead to better EMR use. 2
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