In recent years, there has been a proliferation of health information technologies (HITs) that promise to improve the delivery of care. Health care service providers are faced with an increasing push to develop electronic medical record (EMR) capability, which is the ability to leverage health IT to enable and link the clinical processes for an effective and efficient delivery of care. However, there is little guidance in the literature on the performance implications of EMR capability and whether providers should commit to higher stages of EMR capability. Based on data from 1,011 acute care providers in the United States, the findings of this study suggest that the operational performance of providers, measured as case mix index-adjusted discharges per licensed bed, is positively related to the stage of EMR capability. However, the findings also point to a cautionary insight—committing to higher stages of EMR capability may not be uniformly beneficial to all providers. The findings suggest that the choice of the stage of EMR capability is self-selected. Interestingly, if health care service providers were to be assigned to a higher stage of EMR capability (i.e., incommensurate with their idiosyncratic technological, organizational, and environmental characteristics), the potential operational performance benefit of that stage of EMR capability may remain unrealized.
AbramsonE.HymanD.OsorioS. N.KaushalR. (2009), “Implementing a Patient Safety and Quality across Two Merged Pediatric Institutions,” Joint Commission Journal of Quality and Patient Safety, 35 (1), 43–48.
2.
AbookireS. A.TeichJ. M.SandigeH.PaternoM. D.MartinM. T.KupermanG. J.BatesD. W., (2000), “Improving Allergy Alerting in a Computerized Physician Order Entry System,” Proceedings of the AMIA Symposium, Boston, MA.
3.
AgarwalR.GaoG.DesRochesC.JhaA. K. (2010), “The Digital Transformation of Healthcare: Current Status and the Road Ahead,” Information Systems Research, 21 (4), 796–809.
AngS.CummingsL. L. (1997), “Strategic Response to Institutional Influences on Information Systems Outsourcing,” Organization Science, 8 (3), 235–256.
6.
AngstC. M.DevarajS.QueenanC.GreenwoodB. (2011), “Performance Effects Related to the Sequence of Integration of Healthcare Technologies,” Production Operations Management, 20 (3), 319–333.
7.
AngstC. M.AgarwalR.SambamurthyV. (2010), “Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in US Hospitals,” Management Science, 56 (8), 1219–1241.
8.
AngstC. M.AgarwalR. (2009), “Adoption of Electronic Health Records in the Presence of Privacy Concerns: The Elaboraiton Likelihood Model and Individual Persuasion,” MIS Quarterly, 33 (2), 339–370.
9.
AustinC. J.BowermanS. B. (2003), Information Systems for Health Care Management. Chicago, IL: Health Administration Press.
10.
AyalM.SeidmannA. (2009), “An Empirical Investigation of the Value of Integrating Enterprise Information Systems: The Case of Medical Imaging Informatics,” Journal of Management Information Systems, 26 (2), 43–68.
11.
BaruaA.KonanaP.WhinstonA. B.YinF. (2004), “An Empirical Investigation of Net-Enabled Business Value,” MIS Quarterly, 28 (4), 584–620.
12.
BaruaA.KriebelC. H.MukhopadhyayT. (1995), “Information Technologies and Business Value: An Analytic and Empirical Investigation,” Information Systems Research, 6 (1), 3–23.
13.
BatesD. W.GawandeA. A. (2003), “Improving Safety With Information Technology,” The New England Journal of Medicine, 348 (25), 2526–2534.
14.
BatesD. W.EbellM.GotliebE.ZappJ.MullinsH. C. (2003), “A Proposal for Electronic Medical Records in U.S. Primary Care,” Journal of the American Medical Informatics Association, 10 (1), 1–10.
15.
BharadwajA. S. (2000), “A Resource-Based Perspective on Information Technology Capability and Firm Performance: An Empirical Investigation,” MIS Quarterly, 24 (1), 169–193.
16.
BlumenthalD. (2009), “Stimulating the Adoption of Health Information Technology,” The New England Journal of Medicine, 360 (15), 1477–1479.
17.
BorzekowskiR. (2009), “Measuring the Cost Impact of Hospital Information Systems: 1987–1994,” Journal of Health Economics, 28 (5), 938–949
BurnsL. R.LeeJ. (2008), “Hospital Purchasing Alliances: Utilization, Services, and Performance,” Health Care Management Review, 33 (3), 203–215.
20.
BurnsL. W.WalstonS. L.AlexanderJ. A.ZuckermanH. S.AndersenR. M.TorrensP. R.HilbermanD. (2001), “Just How Integrated are Integrated Delivery Systems? Results from a National Survey,” Health Care Management Review, 26 (1), 20–39.
21.
ChaneyP. K.JeterD. C.ShivakumarL. (2004), “Self-Selection of Auditors and Audit Pricing in Private Firms,” The Accounting Review, 79 (1), 51–72.
22.
ChatterjeeD.GrewalR.SambamurthyV. (2002), “Shaping Up for E-Commerce: Institutional Enablers of the Organizational Assimilation of Web Technologies,” MIS Quarterly, 26 (2), 65–89.
23.
ChauP. Y. K.TamK. Y. (2000), “Organizational Adoption of Open Systems: A Technology-Push, Need-pull Perspective,” Information & Management, 37 (5), 229–239.
24.
ChessonE. (2006), “Radiology is Streamlining,” Health Imaging & IT, 8 (Summer), 36–39.
25.
ChesteenS.HelgheimbB.RandallT.WardellD. (2005), “Comparing Quality of Care in Non-Profit and For-Profit Nursing Homes: A Process Perspective,” Journal of Operations Management, 23 (2), 229–242.
26.
ChaudhuryB.WangJ.WuS.MaglioneM.MojicaW.RothE.MortonS. C.ShekelleP. G. (2006), “Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care,” Annals of Internal Medicine, 144 (10), 742–752.
27.
ClementJ. P.McCueM. J.LukeR. D.BrambleJ. D. (1997), “Strategic Hospital Alliances: Impact on Financial Performance,” Health Affairs, 16 (6), 193–203.
28.
CohenW. M.LevinthalD. A. (1990), “Absorptive Capacity: A New Perspective on Learning and Innovation,” Administrative Science Quarterly, 35 (1), 128–152.
29.
Congressional Research Service (CRS) Report for Congress (2005), “Health Information Technology: Promoting Electronic Connectivity in Health Care,” Information Systems, 16 (4), 121–143.
30.
DavidsonE. J.ChismarW. G. (2007), “The Interaction of Institutionally Triggered and Technology-Triggered Social Structure Change: An Investigation of Computerized Physician Order Entry,” MIS Quarterly, 31 (4), 739–758.
31.
DevarajS.KohliR. (2003), “Performance Impacts of Information Technology: Is Actual Usage the Missing Link?” Management Science, 49 (3), 273–289.
32.
DollW. J.TorkzadehG. (1987), “The Relationship of MIS Steering Committees to Size of Firm and Formalization of MIS Planning,” Communications of the ACM, 30 (11), 972–978.
33.
DruryD. H. (1984), “An Evaluation of Data Processing Steering Committees,” MIS Quarterly, 8 (4), 257–265.
34.
FichmanR. G.KemererC. (1999), “The Illusory Diffusion of Innovation: An Examination of Assimilation Gaps,” Information Systems Research, 10 (3), 255–275.
35.
FormanC. (2005), “The Corporate Digital Divide: Determinants of Internet Adoption,” Management Science, 51 (4), 641–654.
36.
FriedmanL. H.GoesJ. B. (2000), “The Timing of Medical Technology Acquisition: Strategic Decision Making in Turbulent Environments,” Journal of Health Care Management, 45 (5), 317–331.
37.
FurukawaM. S.RaghuT. S.SpauldingT. J.VinzeA. (2008), “Adoption of Health Information Technology for Medication Safety in U.S. Hospitals, 2006,” Health Affairs, 27 (3), 865–875.
38.
GaretsD.DavisM. (2006), “Electronic Medical Records v. Electronic Health records: Yes, there is a Difference,” HIMSS Analytics White Paper, (accessed January 26, 2006), [available athttp://www.himssanalytics.org/docs/wp_emr_ehr.pdf].
39.
GhoshM.JohnG. (2009), “When Should Original Equipment Manufacturers Use Branded Component Contracts with Suppliers?” Journal of Marketing Research, 46 (October), 597–611.
40.
GohJ.GaoG.AgarwalR. (2011, September), “Evolving Work Routines: A Model of Successful Adaptation to Information Technology in Healthcare,” Information Systems Research, , 22 (3), 565–585.
41.
GreeneW. H. (2002), Econometric Analysis, 5th ed. Upper Saddle River, NJ, Prentice Hall.
42.
GrimsonJ.GrimsonW.HasselbringW. (2000), “The SI Challenge in Health Care,” Communications of the ACM, 43 (6), 46–55.
43.
GrosskopfS.ValdmanisV. (1993), “Evaluating Hospital Performance with Case-Mix-Adjusted Outputs,” Medical Care, 31 (6), 525–532.
44.
GuptaY. P.RagunathanT. S. (1989), “Impact of Information Systems (IS) Steering Committees on IS Planning,” Decision Sciences, 20 (4), 777–793.
45.
HamiltonB. H.NickersonJ. A. (2003), “Correcting for Endogeneity in Strategic Management Research,” Strategic Organization, 1 (1), 51–78.
46.
HeckmanJ. (1979), “Sample Selection Bias as a Specification Error,” Econometrica, 47 (1), 153–161.
47.
HillsteadR.BigelowJ.BowerA.GirosiF.MeiliR.ScovilleR.TaylorR. (2005), “Can Electronic Medical Record Systems Transform Health Care? Potential Health benefits, Savings and Costs,” Health Affairs, 24 (5), 1103–1117.
IdsonT.FeasterD. (1990), “A Selectivity Model of Employer-Size Wage Differentials,” Journal of Labor Economics, 8 (1), 99–122.
51.
Institute of Medicine (IOM) (2002), “Key Capabilities of an Electronic Health Record System,” Letter Report, National Academies Press, Washington, DC.
52.
JensenM. C. (1994), “Self-Interest, Altruism, Incentives, and Agency Theory,” Journal of Applied Corporate Finance, 7 (2), 40–45.
53.
JhaA. K.DesRochesC. M.CampbellE. G.DonelanK.RaoS. R.FerrisT. G.ShieldsA.RosenbaumS.BlumenthalD. (2009), “Use of Electronic Health Records in U.S. Hospitals,” The New England Journal of Medicine, 360 (16), 1628–1638.
54.
KazleyA. S.OzcanY. A. (2007), “Organizational and Environmental Determinants of Hospital EMR Adoption: A National Study,” Journal of Medical Systems, 31 (5), 375–384.
55.
KimberlyJ.EvaniskoM. (1981), “Organizational Innovation: The Influence of Individual, Organizational, and Contextual Factors on Hospital Adoption of Technological and Administrative Innovations,” Academy of Management Journal, 24 (4), 689–713.
56.
KohliR.Grover (2008), “Business Value of IT: An Essay for Expanding Research Directions to Keep Up With the Times,” Journal of the Association for Information Systems, 9 (1), 23–39.
57.
KupermanG.GibsonR. (2003), “Computerized Physician Order Entry: Benefits, Costs and Issues,” Annals of Internal Medicine, 139 (1), 31–39.
58.
LiK.PrabhalaN. R. (2007), “Self-Selection Models in Corporate Finance,” in Handbook of Corporate Finance: Empirical Corporate Finance, Vol. 1, Ch. 2, EckboB. E., ed. North-Holland: Elsevier, 37–86.
59.
MaddalaG. S. (1991), “A Perspective on the Use of Limited-Dependent and Qualitative Variables Models in Accounting Research,” The Accounting Review, 66 (4), 788–807.
60.
MaddalaG. S. (1983), Limited-Dependent and Quantitative Variables in Econometrics. Cambridge, UK: Cambridge University Press.
61.
MastenS. E. (1993), “Transaction Costs, Mistakes, and Performance: Assessing the Importance of Governance,” Managerial and Decision Economics, 14 (2), 119–129.
62.
MataF.FuerstW.BarneyJ. (1995), “Information Technology and Sustained Competitive Advantage: A Resource-Based Analysis,” MIS Quarterly, 19 (4), 487–505.
63.
McAfeeA. (2002), “The Impact of Enterprise Information Technology Adoption on Operational Performance: An Empirical Investigation,” Production Operations Management, 11 (1), 33–53.
64.
McCulloughJ. S.CaseyM.MoscoviceI.PrasadS. (2010), “The Effect of Health Information Technology on Quality in U.S. Hospitals,” Health Affairs, 29 (4), 647–654.
65.
McCulloughJ. S. (2005), “The Adoption and Diffusion of Hospital Information Systems,” Doctoral Dissertation, University of Pennsylvania, Pennsylvania, PA.
66.
MekhjianH. S.KumarR. R.KuehnL.BentleyT. D.TeaterP.ThomasA.PayneB.AhmadA. (2002), “Immediate Benefits Realized Following Implementation of Physician Order Entry at an Academic Center,” Journal of the American Medical Informatics Association, 9 (1), 529–539.
67.
MousinG.RemmlingerE.WeilJ. P. (1999), “IT Integration Options for Integrated Delivery Systems,” Healthcare Financial Management, 53 (2), 46–50.
NolanR. L. (1982), “Managing Information Systems by Committee,” Harvard Business Review, 60 (4), 72–79.
71.
Ondategui-ParraS.BhagwatJ.ZouK.NathansonE.GillI.RosP. (2005), “Use of Productivity and Financial Indicators for Monitoring Performance in Academic Radiology Departments: U.S. Nationwide Survey,” Radiology236 (1), 214–219.
72.
OverhageJ. M.SuicoJ.McDonaldC. J. (2001), “Electronic Laboratory Reporting: Barriers, Solutions and Findings,” Journal of Public Health Management Practice7 (6), 60–66.
73.
PalacioC.HarrisonJ. P.GaretsD. (2010), “Benchmarking Electronic Medical Records Initiatives in the US: A Conceptual Model,” Journal of Medical Systems, 34 (3), 273–279.
74.
ParenteS.McCulloughJ. (2009), “Health Information Technology and Patient Safety: Evidence from Panel Data,” Health Affairs, 28(March/April), 357–360.
75.
PavlouP. A.El SawyO. A. (2006), “From IT Leveraging Competence to Competitive Advantage in Turbulent Environments: The Case of New Product Development,” Information Systems Research, 17 (3), 198–227.
76.
PremkumarG.RamamurthyK.CrumM. (1997), “Determinants of EDI Adoption in the Transportation Industry,” European Journal of Information Systems, 6 (2), 107–121.
77.
PremkumarG.RamamurthyK.NilakantaS. (1994), “Implementation of Electronic Data Interchange: An Innovation Diffusion Perspective,” Journal of Management Information Systems, 11 (2), 157–186.
78.
PrestonD. S.LeidnerD. E.ChenD. (2008), “CIO Leadership Profiles: Implications of Matching CIO Authority and Leadership Capability on IT Impact,” MIS Quarterly Executive, 7 (2), 57–69.
79.
PrestonD. S.KarahannaE.RoweF. (2006), “Development of a Shared Understanding Between the Chief Information Officer and Top Management Team in U.S. and French Organizations: A Cross-Cultural Comparison,” IEEE Transactions on Engineering Management, 53 (2), 191–206.
80.
QueenanC. C.AngstC. M.DevarajS. (2011), “Doctors’ Orders—If They’re Electronic, Do They Improve Patient Satisfaction? A Complements/Substitutes Perspective,” Journal of Operations Management, 29 (7-8), 639–649.
81.
RaghupathiW. (1997), “Health Care Information Systems,” CACM, 40 (8), 81–82.
82.
RayG.BarneyJ. B.MuhannaW. A. (2004), “Capabilities, Business Processes, and Competitive Advantage: Choosing the Dependent Variable in Empirical Tests of the Resource-Based View,” Strategic Management Journal, 25 (1), 23–37.
83.
ReichB. H.BenbasatI. (2000), “Factors that Influence the Social Dimension of Alignment Between Business and Information Technology Objectives,” MIS Quarterly, 24 (1), 81–113.
84.
SamaanZ. M.KleinM. D.MansourM. E.DeWittT. G. (2009), “The Impact of the Electronic Health Record on an Academic Pediatric Primary Care Center,” Journal of Ambulatory Care Management, 32 (3), 180–187.
85.
SchiffG. D.KlassD.PetersonJ.ShahG.BatesD. W. (2003), “Linking Laboratory and Pharmacy: Opportunities for Reducing Errors and Improving Care,” Archives of Internal Medicine, 163 (8), 893–900.
86.
SchnellerE. S. (2000), The Value of Group Purchasing in the Health Care Supply Chain. Tempe: School of Health Administration and Policy, Arizona State University.
87.
ShaverJ. M. (1998), “Accounting for Endogeneity when Assessing Strategy Performance: Does Entry Mode Choice Affect FDI Survival,” Management Science, 44 (4), 571–585.
88.
ShehataM. (1991), “Self-selection Bias and the Economic Consequences of Accounting Regulation: An Application of Two-Stage Switching Regression to SFAS No 2,” The Accounting Review, 66 (4), 768–787.
89.
ShuklaR. K.PestianJ.ClementJ. (1997), “A Comparative Analysis of Revenue and Cost-Management Strategies of Not-for-Profit and For-Profit Hospitals,” Hospital Health Service Administration, 42 (1), 117–134.
90.
SmaltzD. H.SambamurthyV.AgarwalR. (2006), “The Antecedents of CIO Role Effectiveness in Organizations: An Empirical Study in the Health Care Sector,” IEEE Transactions on Engineering Management, 53 (2), 207–222.
91.
SobolM. G.KleinG. (2009), “Relation of CIO Background, IT Infrastructure, and Economic Performance,” Information and Management, 46 (5), 271–278.
92.
TabakL.JainB. (2000), “Predicting Hospital Innovativeness: An Exploration of the Perceived Organizational Context,” Journal of Applied Management Studies, 9 (2), 217–226.
93.
TangP. C.AshJ. S.BatesD. W.OverhageJ. M., D. Z. & Sands (2006), “Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption,” Journal of The American Medical Informatics Association, 13 (2), 121–126.
94.
TeoH. H.WeiK. K.BenbasatI. (2003), “Predicting Intention to Adopt Interorganizational Linkages: An Institutional Perspective,” MIS Quarterly, 27 (1), 19–49.
95.
ThirumalaiS.SinhaK. K. (2012), “To Personalize or Not to Personalize Online Purchase Interactions: Implications of Self-Selection by Retailers,” Information Systems Research (forthcoming).
96.
TierneyW. M.McDonaldC. J.MartinD. K.RogersM. P. (1987), “Computerized Display of Past Test Results. Effect on Outpatient Testing,” Annals of Internal Medicine, 107 (4), 569–574.
97.
ZahraS. A.GeorgeG. (2002), “Absorptive Capacity: A Review, Reconceptualization, and Extension,” The Academy of Management Review, 27 (2), 185–203.
98.
ZhuK.KraemerK. L.XuS. (2006), “The Process of Innovation Assimilation by Firms in Different Countries: A Technology Diffusion Perspective on E-Business,” Management Science, 52 (10), 1557–1576.
99.
ZhuK.KraemerK. L. (2005), “Post-Adoption Variations in Usage and Value of E-Business by Organizations: Cross-Country Evidence from the Retail Industry,” Information Systems Research, 16 (1), 61–84.
100.
ZhuK.KraemerK. L.XuS. (2003), “E-business Adoption by European Firms. A Cross Country Assessment of the Facilitators and Inhibitors,” European Journal of Information Systems, 12 (4), 251–268.
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