The Electronic Medical Record Adoption Process: Impact on Patient Experience and Cost

This research investigates the process of adoption of Electronic Medical Record (EMR) technologies in US hospitals. We argue that this process consists of two dimensions: sequence and speed. Sequence represents the order in which the hospital adopts EMR technologies, while speed represents the pace at which it adopts them. Specifically, we examine the interplay between two different sequences of adoption (sequential and parallel) and speed and how they affect hospital performance. In the sequential approach, technology implementation starts at the department level before expanding hospital-wide. The parallel approach begins with adopting hospital-wide technologies in tandem with, or before, adopting department-level technologies. We measure hospital performance using operating cost and experiential quality, measured as the quality of interactions between patients and caregivers. We use longitudinal data from 895 hospitals between 2007 and 2012 to investigate our research questions. Results indicate a sequential approach costs less and harms experiential quality less than a parallel approach. With an increase in adoption speed, however, these benefits tend to deteriorate at a comparably faster rate for the sequential approach. We also find that large teaching hospitals tend to pursue a parallel approach, but the 2009 passage of the HITECH Act has prompted smaller hospitals to follow suit, resulting in poor experiential quality outcomes. Taken together, our results suggest the importance of looking at sequence and speed dimensions when adopting technologies. It also suggests the need to restructure HITECH Act incentives.  

Information:  Dr. M. Schmidt, tel. 82199, e-mail: schmidt2@rsm.nl