Unlocking the Transformative Potential of Health Information Technology (Health IT): Institutional, Ecological & Contextual Influences Shaping Health IT Adoption Regionally


May 2023


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Since the 1960s, health IT has evolved into a variety of forms and functions, embedded in all aspects of hospital care. This innovation explosion paved the ways for new ways of delivering care, including wearable and portal technologies that empower the individual to be more knowledgeable of, and involved in their own care. At the same time, adoption of these technologies has been slower than anticipated -- or desired -- among healthcare leaders. In response, President Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act of 2009 “to promote the adoption and meaningful use of health information technology” (HHS.gov). While this federal policy was undoubtedly successful in spurring adoption and implementation of health IT, some hospitals did so more rapidly than others. Knowing what we know about innovation characteristics and given promising outcomes of health IT adoption, it is reasonable to assume that we may not have yet witnessed the full extent of health IT’s potential and are likely just at the cusp of its explosive growth. It is therefore important to understand the barriers to, and facilitators of, health IT adoption, so we can ensure a nurturing environment for innovation adoption and implementation. Review of the literature shows that overall focus has been on factors that emanate from within the hospital, while few have focused on factors external to hospitals. This study utilizes cross-sectional data to build and test models of the hypothesized influence of hospital-related regional factors on the adoption of computer practitioner order entry (CPOE) technology across metropolitan regions, while controlling for the influence of hospital ecosystem, regional health IT support, regional economic, regional social demographic, regional vitality-impacting, regional healthcare access and population health factors. This study aims to answer the question, “What factors influence the adoption of health information technology?” Part 1 of the analysis examined the influence of static physical capital (measured as average hospital size within the region) on the adoption of CPOE by 2012 (DV1). It revealed that this dimension of hospital-related regional factors, had a positive effect, meaning that as average hospital size for the region increased, adoption of CPOE technology among hospitals in the region also increased. In contrast, Part II analyses, which focused on the next five years (2012- 2017), revealed that hospitals’ health IT investment decision-making across the region was negatively influenced by the region’s growth in physician ranks perhaps because a national Medicaid expansion policy in 2014 signaled growing healthcare utilization. Modeling for DV1 also demonstrated that health IT decision-making by hospitals in the region is exposed to a wider variety of external influences beyond those emanating from the hospital alone, such as the healthcare ecology of a region, regional economic performance, and healthcare access. For healthcare sector and government leaders, this is important to be aware of because it helps define likely patterns of health IT adoption from a regional perspective and the likely regional profiles of healthcare transformation.



Political Science, General