Adopción de tecnología informática en hospitales

Hospital IT Adoption Strategies Associated with Implementation Success: Implications for Achieving Meaningful Use
Eric W. Ford, PhD, Forsyth Medical Center Distinguished Professor, University of North Carolina Greensboro; Nir Menachemi, PhD, associate professor, University of Alabama at Birmingham; Timothy R. Huerta, PhD, director and assistant professor, Center for Health Information, Educationand Research, Texas Tech University, Lubbock; and Feliciano Yu, MD, CPHIMS, assistant professor, Department of Pediatrics, University of Alabama at Birmingham School of Medicine

EXECUTIVE SUMMARY Health systems are facing significant pressure to either implement health information technology (HIT) systems that have “certified” electronic health record applications and that fulfill the federalgovernment’s definition of “meaningful use” or risk substantial financial penalties in the near future. To this end, hospitals have adopted one of three strategies, described as “best of breed,” “best of suite,” and “single vendor,” to meet organizational and regulatory demands. The single-vendor strategy is used by the simple majority of U.S. hospitals, but is it the most effective mode forachieving full implementation? Moreover, what are the implications of adopting this strategy for achieving meaningful use? The simple answer to the first question is that the hospitals using the hybrid best of suite strategy had fully implemented HIT systems in significantly greater proportions than did hospitals employing either of the other strategies. Nonprofit and system-affiliated hospitals weremore likely to have fully implemented their HIT systems. In addition, increased health maintenance organization market penetration rates were positively correlated with complete implementation rates. These results have ongoing implications for achieving meaningful use in the near term. The federal government’s rewards and incentives program related to the meaningful use of HIT in hospitals hascreated an organizational imperative to implement such systems. For hospitals that have not begun systemwide implementation, pursuing a best of suite strategy may provide the greatest chance for achieving all or some of the meaningful use targets in the near term or at least avoiding future penalties scheduled to begin in 2015.
For more information on the concepts in this article, contact Dr. Ford atewford@uncg.edu.

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J o u r n a l o f H e a l t h c a r e M a n a g e m e n t 55:3 May/June 2010

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.S. hospitals are implementing health information technologies (HITs) throughout their facilities to meet a variety of business imperatives arising from within and outside the organization. Within hospitals, the promise of better operationalefficiency and clinical outcomes leading to improved financial performance are driving HIT diffusion (Burke et al. 2009) but have yet to be demonstrated (Himmelstein, Wright, and Woolhandler 2010). Forces external to hospitals include stakeholder demands (Scanlon, Christianson, and Ford 2008) and the promise of rewards from the federal government for implementing a “certified” electronic health record(EHR) system that achieves meaningful use goals by 2011 and 2013 (Greene 2009). Beyond those deadlines, the threat of penalties for failing to meet certification and meaningful use standards begins as soon as 2015 (MGMA 2009). Collectively, the internal demands coupled with external and regulatory forces make the need to fully implement HIT systems with wideranging capabilities an organizationalimperative for hospital administrators. Hospitals have experienced significant delays and outright failures in their attempts to implement complex HIT systems that satisfy the EHR meaningful use criteria promulgated in 2009 (Kaplan and Harris-Salamone 2009; Scott et al. 2005). One study estimated that less than 8 percent of U.S. hospitals have in place a basic EHR system that might satisfy the...