Factors that Determine Comprehensive Categorical Classification ofEHR Implementation Levels

摘要

Electronic Health Records (EHRs) have the potential to alleviate patient safetymistakes. Of the various levels of EHR, advanced or higher-level functionalitiesof EHR are designed to improve patient safety. Certain organizational andenvironmental factors may pose as barriers toward implementing all of thefunctionalities, leaving certain hospitals intermediate between basic andcomprehensive levels of implementation. This study identifies a comprehensivecategorical classification that includes hospitals that have functionalitiesbetween basic and comprehensive levels of EHR and determines the organizationaland environmental factors that may influence hospitals to implement one or morecombinations of these categories. A longitudinal panel design was used. Ordinallogistic regression with random effects model was fitted with robust clusterstandard errors. Our sample consisted of non-federal general acute carehospitals utilizing a panel design from 2010 to 2016 with 17 586 hospital-yearobservations (or an average of 2600 hospitals per year). Larger size hospitals,ones with higher total margin, metropolitan and urban hospitals, systemaffiliated hospitals, and those in higher managed care penetration areas havehigher odds of belonging in one of the higher categories of EHR implementation.Hospitals that can access a greater amount of human resources and financialassets from their environments, may implement higher levels of EHR. Initial andmaintenance costs of EHR, interoperability issues, and inability to distributehigh costs of training across facilities may stymie implementation of higher EHRfunctionalities. Policymaking to encourage competition among vendors maypossibly lower the implementation price for hospitals with limitedresources.