29 Profile of the digitization of patient medical records in Dutch hospitals decision support [CDSS]). Progressing past EMRAM Stage 5, CLMA must be live in all inpatient units (EMRAM Stage 7 requirement) or at least in one clinical unit (EMRAM Stage 6 requirement). Only 11 hospitals in the NL had surpassed EMRAM Stage 5 requirements during the time of this study. Note that in March 2015, one NL hospital successfully met all of the requirements to satisfy EMRAM Stage 7 (UMC Radboud in Nijmegen), becoming the third hospital in all of Europe to achieve this distinction (Hospital de Dénia Marina Salud in Denia, Spain, University Medical Center Hamburg-Eppendorf, Germany, and RadboudUMC in Nijmegen, The Netherlands). RESULTS OF TESTS REGARDING THE HYPOTHESES University hospitals in the Netherlands are a special group. They have different financial models, have special teaching and research missions, and are in general a lot larger than other hospitals in the NL. They combine ICT efforts for healthcare, education, and research, and have more advanced ICT organizations; although, some are struggling with the more advanced position. Teaching hospitals and general hospitals are more focused on patient throughput than university hospitals; this has to do with the different missions and financial model. For this reason, the university hospitals were excluded, with the exception of hypothesis H4, where those hospitals are compared with the other hospitals. H1: Hospitals in a lower population density area are less likely to have advanced EMR capabilities. The ‘Randstad’ area of NL (defined by the area around Amsterdam, The Hague, Rotterdam, and Utrecht, with 40% of the total population of the Netherlands) has a much higher concentration of individuals (population density =3267/km2) than the other regions of the country (average population density of the non-Randstad region = 1186/ km2) (see Table 3). In comparing the EMR profiles of the densely populated Randstad region hospitals to hospitals in the other lower densely populated regions, we find no support for our first hypothesis. On the contrary, the lowest scoring hospitals (52.2% versus 30.2%) are in areas of higher population density. 2
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