Antecedents of Clinical Information Technology Sophistication in Hospitals
Jaana, M., Ward, M.M., Paré, G. & Sicotte, C. "Antecedents of Clinical Information Technology Sophistication in Hospitals", Health Care Management Review, 31(4), 2006, pp.289-299.
Research Question and Study Overview:
Grounded in the resource-based theory and the innovation diffusion theory, this article develops and tests a research model for assessing the antecedents of hospital innovativeness with regard to the adoption of clinical IT applications. Building on other researchers’ findings showing differences between innovative and non-innovative organizations in respect to their internal, external, and leadership characteristics, the authors examine those characteristics or factors that influence the level of clinical IT sophistication in hospitals.
Using a measurement instrument (previously developed by two of the authors), the study identifies and operationalizes ‘‘clinical IT sophistication’’ in hospitals along three dimensions:
(1) functional sophistication, referring to the computerization of various clinical and administrative processes and activities (e.g., patient admission, discharge and transfer, ER, operating room, pharmacy, laboratories);
(2) technological sophistication, referring to the extent of use of specific technologies in the clinical areas mentioned above; and
(3) integration level, reflecting the level of internal and external integration of various systems and technologies.
The study links hospital innovativeness in clinical IT to certain organizational capacity characteristics that fall into four specific conceptual domains:
• structural capacity (primarily organization’s size)
• financial resources (including such major factors as public-sector payer mix)
• leadership capacity (reflecting managers’ length of tenure, level of education, etc.)
• knowledge sharing capacity (specialized IT staff and membership in a network/system
Data sources and methodology:
A cross-sectional survey was conducted among non-federal hospitals in the state of Iowa, using regular mail, with follow-up over the phone. Secondary data from the American Hospital Association (AHA) annual survey of hospitals were used to identify the remaining organizational capacity variables. Various forms of statistical analysis were performed to measure the antecedents divided into four conceptual domains/groups of organizational capacity variables.
A significant percentage (45% to 61%) of the variance in clinical IT sophistication was explained mostly by leadership and knowledge sharing capacities. In particular, IT tenure and technical knowledge resources were significantly related to clinical IT sophistication.
However, financial resources and structural capacity did not play an important role in determining the level of clinical IT sophistication. It appeared that for these mostly rural hospitals with negative operating margins from patient care, financial constraints were not the main factors affecting the decision to acquire new technologies.
Surprisingly, managerial tenure and hospital’s belonging to a network showed significant negative associations with two dimensions of the clinical IT sophistication, which might indicate some resistance among individuals who have been in charge of hospital IT activities for a long time to introduce IT-based innovations. This raises important questions in relation to the current management in hospitals, and their ability to adapt to new technologies and transform hospitals for better performance and patient care support.
The findings of this study suggest that human factors play the primary role in shaping hospitals’ technological innovativeness in the clinical field. To address the challenges they face, hospitals should consider encouraging career development for current IT managers, and attracting professionals with an IT background who have the knowledge and ability to trigger new ideas and favor the adoption and use of clinical IT applications.
Alexey Panchenko, MBA, MS
NLM Fellow, OHSU, DMICE