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Small hospitals owned by multihospital systems have higher levels of electronic medical record adoption

Large (more than 150 beds) and medium (26-150 beds) hospitals tend to have more advanced health information technology (HIT) capacity than small hospitals (25 or fewer beds), regardless of their affiliation with a health care system. In contrast, small hospitals owned by multihospital systems have more HIT capacity than small independent hospitals.

A team of researchers analyzed 4 stages of electronic medical record (EMR) adoption among 4,017 U.S. hospitals. Stage 0 hospitals did not install all three ancillary systems (laboratory, pharmacy, and radiology), while stage 1 hospitals installed all three systems. Stage 2 hospitals had stage 1 capacity plus a clinical data repository. Stage 3 hospitals had stage 2 capacity and other advanced HIT applications such as order entry, nursing documentation, electronic medication administration record, clinical decision support systems, and picture archiving.

The mean EMR adoption stage was significantly different between small (0.85), medium (1.53), and large (1.79) hospitals. The level of EMR adoption did not differ among medium and large hospitals that belonged to a hospital system or were independent. However, small hospitals that were owned by a multihospital system had a significantly higher EMR adoption level than small independent hospitals (1.08 vs. 0.77). Large hospitals tend to have the capacity and resources to afford innovations and to invest in HIT.

Better access to capital and purchasing efficiencies may be the most important factors for small hospitals struggling to improve their HIT capacity. Given that most hospitals with 25 or fewer beds are located in rural areas, this study presents important findings for small rural hospitals. The study was supported by the Agency for Healthcare Research and Quality (HS15009).

More details are in "Role of multihospital system membership in electronic medical record adoption," by Pengxiang Li, Ph.D., James A. Bahensky, M.S., Mirou Jaana, Ph.D., and Marcia M. Ward, Ph.D., in the April-June 2008 Health Care Management Review, 33(2), pp. 169-177.

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