Darrell Burke

Exploring Hospitals' Adoption of Information Technology

This study explores the adoption of information technology (IT) and the association between organizational and market factors, and IT adoption in hospitals. Results suggest that a wide range of amounts and types of IT are adopted. Hospitals with higher overall IT adoption adopt strategic IT most often. Hospitals with lower IT adoption adopt administrative IT most often. Results also show hospital IT adoption to be positively associated with hospital size, location, system membership, ownership, and market competition.

Hospital information technology and positive financial performance: a different approach to finding an ROI.

EXECUTIVE SUMMARY This empirical study examined the relationship between information technology (IT) utilization and hospital financial performance. Using primary and secondary data, we specified and tested a series of regression models that examined this relationship in Florida hospitals. In addition, we employed performance group analysis for a select group of operational performance indicators. Findings suggested a significant and positive relationship between increased levels of IT use and various measures of financial performance, even after controlling for case‐mix acuity and bed size. Regardless of the analysis or method employed, the results indicated that IT adoption is consistently related to improved financial outcomes both overall and operationally. This relationship was present when examining IT collectively and for clinical IT, administrative IT, and strategic IT as individual measures. Lastly, although higher IT use was associated with a higher level of revenues, income, or cash flow, higher use was also associated with ratios based on higher expenses. This probably reflects the relatively high acquisition costs associated with obtaining and maintaining sophisticated IT systems. Given that a true return on investment is so difficult to obtain for many individual hospitalwide IT systems, our data can serve as a proxy for hospital leaders and policymakers who want to understand the potential financial effects of investing in IT in the acute care setting.

Factors Affecting the Adoption of Telemedicine—A Multiple Adopter Perspective

This paper utilizes the diffusion of innovation framework to discuss factors affecting adoption of telemedicine. Empirical and anecdotal findings are organized across five attributes affecting innovation adoption rates for the following four adopter groups: physicians, patients, hospital administrators, and payers. A discussion of the implications is included.

Patient Safety-Related Information Technology Utilization in Urban and Rural Hospitals

Ongoing research has linked certain information technology applications to reduction of medical errors and improved patient outcomes. The purpose of this study was to assess both the use of patient safety-related information technologies (PSIT) in urban and rural hospitals, as well as the organizational factors which may be linked to overall PSIT adoption. Florida’s 199 acute care hospitals (170 urban; 29 rural) were surveyed regarding their utilization of PSIT. Of the 10 technologies studied, rural hospitals averaged 30% utilization compared to 48% for urban hospitals. Individual PSIT applications such as pharmacy-based systems, clinical decision support systems, and outcomes and quality management tools were all more likely to be present in urban hospitals. Hospital bed size (less than 100 beds), tax status (not-for-profit vs. for-profit), and system-affiliation appeared to be related to overall PSIT utilization. These findings are valuable for those interested in the current status of hospital PSIT and set the stage for further studies relating these applications to clinical outcomes in urban and rural hospitals.

Diffusion of information technology supporting the Institute of Medicine's quality chasm care aims.

&NA; This article examines the degree to which healthcare information technology (HIT) supporting the Institute of Medicines (IOM) six care aims is utilized in the hospital setting and explores organizational factors associated with HIT use. Guided by the IOMs Crossing the quality chasm report and associated literature, 27 applications and/or capabilities are classified according to one or more of the six care aims. A structured survey of Florida hospitals identified the use of HIT. Results suggest that, on average, hospitals have not yet embraced HIT to support the IOMs care aims and that associated organizational factors vary according to care aim.

To outsource or not to outsource: Examining the effects of outsourcing IT functions on financial performance in hospitals.

BACKGROUND Outsourcing of information technology (IT) functions is a popular strategy with both potential benefits and risks for hospitals. Anecdotal evidence, based on case studies, suggests that outsourcing may be associated with significant cost savings. However, no generalizable evidence exists to support such assertions. PURPOSE This study examines whether outsourcing IT functions is related to improved financial performance in hospitals. METHODOLOGY Primary survey data on IT outsourcing behavior were combined with secondary data on hospital financial performance. Regression analyses examined the relationship between outsourcing and various measures of financial performance while controlling for bed size, average patient acuity, geographic location, and overall IT adoption. FINDINGS Complete data from a total of 83 Florida hospitals were available for analyses. Findings suggest that the decision to outsource IT functions is not related to any of the hospital financial performance measures that were examined. Specifically, outsourcing of IT functions did not correlate with net inpatient revenue, net patient revenue, hospital expenses, total expenses, cash flow ratio, operating margin, or total margin. PRACTICE IMPLICATIONS In most cases, IT outsourcing is not necessarily a cost-lowering strategy, but instead, a cost-neutral manner in which to accomplish an organizational strategy.

Are consumers reshaping hospitals? Complementary and alternative medicine in U.S. Hospitals, 1999-2003.

Abstract: All types of acute care hospitals across the U.S. are becoming increasingly involved in offering CAM services. Hospitals appear to be responding to consumer demand, CAM specific market forces, and their organizational missions but not to regulatory mandates.

Health care CIOs: assessing their fit in the organizational hierarchy and their influence on information technology capability.

Despite the continuing interest in the importance of health care information technology adoption, very little is known about chief information officers (CIOs), the individuals who manage this effort. The present study surveyed hospital CIOs to understand their backgrounds, their organizational status, and their influence in hospital health care information technology adoption. Survey responses from 98 organizations suggest that the CIO position varies significantly according to the profit status of the hospital. Further, regression analyses suggest that CIO tenure is associated with greater health care information technology adoption, whereas the reporting structure of the CIO is not. Management implications of the findings are discussed.

Hospital financial performance: does IT governance make a difference?

This study examined whether information technology (IT) governance, a term describing the decision authority and reporting structures of the chief information officer (CIO), is related to the financial performance of hospitals. The study was conducted using a combination of primary survey data regarding health care IT adoption and reporting structures of Florida acute care hospitals, with secondary data on hospital financial performance. Multiple regression models were used to evaluate the relationship of the 3 most commonly identified reporting structures. Outcome variables included measures of operating revenue and operating expense. All models controlled for overall IT adoption, ownership, membership in a hospital system, case mix, and hospital bed size. The results suggest that IT governance matters when it comes to hospital financial performance. Reporting to the chief financial officer brings positive outcomes; reporting to the chief executive officer has a mixed financial result; and reporting to the chief operating officer was not associated with discernible financial impact.

Hospital budget increase for information technology during phase 1 meaningful use.

Federal policies have a significant effect on how businesses spend money. The 2009 HITECH (Health Information Technology for Economic and Clinical Health Act) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use certified electronic health records privately and securely to achieve specified improvements in care delivery. Federal incentive payments were offered in 2011 for hospitals that had satisfied “meaningful use” criteria. A longitudinal study of nonfederal hospital information technology (IT) budgets (N = 493) during the years 2009 to 2011 found increases in the percentage of hospital annual operating budgets allocated to IT in the years leading up to these federal incentives. This increase was most pronounced among hospitals receiving high proportions of their reimbursements from Medicaid, followed by hospitals receiving high proportions of their reimbursements from Medicare, possibly indicating a budget shift during this period to more IT spending to achieve meaningful-use policy guidelines.