Adoption of Health Information Technology Systems among U.S. Hospitals 2007-2012 Open Access

Abstract

Health information technology (HIT) systems are diverse and play varied roles in improving healthcare delivery. Despite the current push for the advancement of HIT infrastructure in the U.S., adoption rates of HIT systems have been slower than expected. In addition, most studies that examine adoption rates focus on specific systems or use non-weighted aggregation. This study investigated the diffusion of HIT systems by employing a novel, weighted scale aggregating 18 different clinical IT systems. We employed proportional hazard modelling to estimate the time to adoption for basic, medium and advanced levels of HIT infrastructure, and control for hospital organizational factors. Our results indicate that small hospitals (<100 beds) are falling the furthest behind in HIT adoption, and may be failing to implement even rudimentary HIT technologies. Also, rural and for-profit hospitals, as well as hospitals with poor network involvement are lagging behind national averages. As the U.S. moves toward a nationwide network of intercommunicating health technologies, these hospitals may become stumbling blocks in the provision of safe, timely, and effective care. Policy should be targeted to lagging hospitals in order to meet HIT adoption goals and prevent the technological gap from widening.

Table of Contents

INTRODUCTION. 1

LITERATURE REVIEW. 2

Health information technology systems. 2

Adoption trends before the HITECH Act. 3

HITECH Act. 3

Adoption trends after the HITECH Act. 4

The Digital Divide - differences between early and late adopters. 5

Measures of HIT adoption. 6

Gaps in literature. 7

METHODS. 7

Conceptual Framework - Diffusion of Innovation Theory and Dissemination Science. 7

Dataset and Analytic Sample. 12

Research Questions and Hypothesis. 12

Dependent Variable. 12

Independent Variables. 14

Research Design. 15

RESULTS. 16

Cohort descriptives. 16

CITA scores. 17

Proportional hazard models. 20

DISCUSSION. 23

Summary. 23

Limitations. 25

Policy Implications. 26

Future Research. 28

CONCLUSION. 29

REFERENCES. 30

APPENDICES. 37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Health information technology Diffusion of innovation Health Information Technology for Economic and Clinical Health (HITECH) Act
Committee Chair / Thesis Advisor	Hockenberry, Jason Michael, Emory University
Committee Members	Gaydos, Laurie, Emory University Becker, Edmund R, Emory University Sanfilippo, Fred, Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

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