33 Profile of the digitization of patient medical records in Dutch hospitals TABLE 7: Average Hospital ICT Budgets by EMRAM Stage Stage 0-2 Stage 3-5 Stage 6 and 7 Mean Mean Mean ICT budget in € millions 5.1914 6.7400 8.3000 ICT budget as percentage of hospital budget 3.06% 3.63% 4.17% Hospitals with higher IT budgets score better. H6: Hospitals with more ICT employees have more advanced EMR capabilities. The findings of this study support the hypothesis that hospitals withmore ICT employees tend to have more advanced EMR capabilities. As reflected in Table 8, the number of ICT workers per hospital bed increases with advancing EMR capabilities. These findings unfortunately do not detail the type of ICT workers. Future research efforts might want to consider if there is a shifting demand in the type of ICT worker as hospitals progress in their EMR capabilities. TABLE 8: Average Number of ICT Employees by EMRAM Stage Stage 0-2 Stage 3-5 Stage 6 and 7 Mean Mean Mean numbers of ICT employees per hospital bed 0.0782 0.0831 0.1015 Hospitals with more ICT employees tend to have more advanced EMR capabilities DISCUSSION Leveraging the HIMSS Analytics EMRAM to define the basic EMR as one that exceeds the infrastructure of an EMRAM Stage 5 hospital, we found that only 15.3% of NL hospitals during our study period had a basic EMR system in at least one clinical area (EMRAM Stage 6). With so few NL hospitals operating a basic EMR system, we are left to question those factors that might be at work influencing a hospital’s EMR progression. This study considered two major classes of variables: the EMRAM requirements themselves and intervening organizational and environmental forces. With respect to EMRAM requirements, the findings of this analysis suggest NL hospitals may be particularly challenged in addressing one distinct requirement of the HIMSS Analytics EMRAM. With 37.5% of hospitals having successfully met the requirements of Stage 2 but not Stage 3, the requirements of Stage 3 appear to be a challenge for a sizeable percentage of NL hospitals. And indeed, when looking further into the data, we find that electronic nursing/clinical documentation presents as a particular challenge. We are uncertain as 2
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