35 Profile of the digitization of patient medical records in Dutch hospitals group purchase and implementation of EMRs. Because EMRs are expensive, and larger hospitals have begun using EMRs more than smaller hospitals, it is possible that without greater economies of scale for implementation, EMRs are too costly for the smaller hospitals. If EMRs do in fact improve hospital quality or efficiency, policymakers should take steps to encourage hospital EMR use. These steps could include programs that aid hospitals in implementing and using EMRs with EMR hardware and software, as well as training and personnel to help with implementation. These programs will be especially important to smaller hospitals. Policymakers may also, at some point, offer greater financial reimbursement for hospitals that use EMRs as a way to encourage hospital use. Additionally, more regulations frompayer groups and policymakers can ensure that hospital EMR use is practiced. These regulations may be in the form of requirements for certification, endorsements, or accreditation. Previous research has concluded similar incentives are necessary for more widespread EMR adoption. 19 Three of the six university hospitals represented in this study (total of eight university hospitals in the Netherlands) have full EMR systems in use in at least one clinical unit. University hospitals have far more resources than non-university hospitals and have a different financial model with more government funding. They have more IT budget and more ICT employees. Teaching hospitals are well represented in the group that is implementing additional functionalities, which also reflects other findings. They have higher and better resources. Hospitals with higher ICT budgets were expected to do better, which is the case. CONCLUSION Although small hospitals and hospitals located in the northern part of the Netherlands were underrepresented in the study, the 72 hospitals that did participate provided a fairly good representation of the total population of the Netherland’s 93 hospitals. Although the group is relatively small, and no robust statistically significant conclusions could be drawn, three of the six hypotheses were supported. Adoption and use of the EMR tends to be positively associated with larger hospitals and teaching hospitals. Not found was a relationship between hospital density and population density, as a measure for the competition level, and the EMRAM score. According to the Resource Dependence theory, resources in areas with low density populations are scarcer in areas of lower population, (potential) patients have less choice, and hospitals feel less urgency to adopt advanced technologies like EMRs. No proof was found for this statement in the Netherlands in this study. Competition in the Netherlands is a new and developing phenomenon. The healthcare insurance companies and the Government play a dominant role. So 2
RkJQdWJsaXNoZXIy MjY0ODMw