Linking Electronic Medical Records Use to Physicians’ Performance: A Contextual Analysis

Abstract

Electronic Medical Records (EMR) studies have broadly tested EMR use and outcomes, producing mixed and inconclusive results. This study carefully considers the healthcare delivery context and examines relevant mediating variables. We consider key characteristics of: (i) interdependence in healthcare delivery processes, (ii) physician autonomy, and (iii) the trend of hospital employment of physicians, and draw on theoretical perspectives in coordination, shared values, and agency to explain how the use of EMR can improve physicians' performance. In order to examine the effects of physician employment on work practices in the hospital, we collected 583 data points from 302 hospitals in 47 states in the USA to test two models; one for employed and another for nonemployed physicians. Results show that information sharing and shared values among healthcare delivery professionals fully mediate the relationship between EMR use and physicians' performance. Next, physician employment determines which mediating variable constitutes the pathway from EMR use to physicians' performance. Finally, we highlight the impact of shared values between the hospital and physicians in enhancing information sharing and physicians' performance, extending studies of these behaviors among network partners in industrial settings. Overall, our study shows that EMR use should be complemented by processual (information sharing), social (shared values), and structural (physician employment) mechanisms to yield positive effects on physicians' performance.

Examining Governance in Hospital Operations: The Effects of Trust and Physician Employment in Achieving Efficiency and Patient Satisfaction

“…= .09, t = 1.43, p > .10). These results are consistent with recent healthcare IT and OM studies that have employed similar methods and obtained similar results (Dobrzykowski & Tarafdar, ). Summarizing the results, informal relational governance and formal incentive system governance mechanisms appear to work in tandem to moderate the relationships among strategy, structures/processes, and performance.…”

Understanding the Downstream Healthcare Supply Chain: Unpacking Regulatory and Industry Characteristics

“…While physician employment may seem to be a silver bullet in improving downstream (hospital) performance, healthcare service research has revealed that it has no effect on employed physicians’ HIT use (Bishop, Shortell, Ramsay, Copeland & Casalino, ) nor improvements in key outcomes such as satisfaction scores, lengths of stay, mortality rates, or 30‐day readmissions rates for most conditions (Budryk, ). Early HIT studies from operations and supply chain researchers have revealed important cognitive and relational mediating factors as key to improving patient satisfaction and physician performance when employing physicians (Dobrzykowski & Tarafdar, , ) as well as associations between physician employment and reduced supply expense (Abdulsalam, Gopalakrishnan, Maltz & Schneller, ) and improved supply chain performance (Nyaga, Young & Zepeda, ; Young et al., ). These early studies provide a useful starting point for additional research into the nuanced mediating and moderating relationships, as well as the more directional strategy—outcomes relationships, that involve physician employment as a hospital—physician coordination mechanism.…”

Sustainable Supply Chain Management Practices and Sustainable Performance in Hospitals: A Systematic Review and Integrative Framework

“…In other words, lack of training and education of supply chain professionals and executives is a common barrier [17,61], as is proneness to issues like sharing information, which pivots on organizational culture [17]. Variables like shared values have proven to play a mediating role between other variables, such as the use of electronic medical records and physicians´performance [120], while willingness to support the implementation of practices depends on individual interests and the degree to which they make true sense for employees, patients, and the community [50].…”