AJMC: Hospital leadership impacts EHR adoption

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Adoption of EHRs might relate to leadership influence, change management methods and other organization-level variables, according to an article in the April edition of the American Journal of Managed Care.

“Physician-hospital alignment was a strong predictor of adoption. Individual characteristics of the adopter did not consistently predict adoption. Although consistently shown to be a predictor in extant literature, age had no significant effect on adoption,” wrote John S. Hudson, RN, PhD, a director at Sentara Healthcare in Newport News, Va., and colleagues.

The researchers aimed to predict adoption (80 percent rate of use) of an EHR by admitting physicians using a heuristic model. Administrative data collected for 326 physicians who admitted at least 10 patients to three hospitals during the six months following EHR activation represented more than 80 percent of the total admissions. Functions evaluated included computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS).

CPOE adoption was more likely for physicians who were employed, male and had a high inpatient ratio, a lower patient volume and a community hospital setting, according to the authors.

The likelihood of EH&P adoption was higher for the large academic hospital compared with the mid-sized community hospital or small community hospital; higher for contracted physicians and employed physicians compared with competing physicians; higher for women compared with men; and lower for physicians with discharges above the median (more than 70 discharges) compared with physicians with discharges in the first quartile.

The likelihood of EDS adoption was higher for the large academic hospital compared with the mid-sized community hospital and the small community hospital; higher for independent physicians, contracted physicians and employed physicians compared with competing physicians; higher for surgical specialists compared with medical specialists; and lower for hospital-based physicians compared with those who were not hospital based, according to the authors.

“Interestingly, organizational-level variables and level of physician-hospital alignment were more predictive than individual physician-level variables,” the authors concluded. “The hospital type was significantly associated with adoption of all three EHR functions. The direction of that association varied and may suggest that leadership, change management methods, social norms at each facility or other environmental factors affect adoption differently for different functions in the EHR software.”