Variation in electronic health record adoption in European public hospitals: a configurational analysis of key functionalities

The potential of electronic health record (EHR) to support the delivery of health care and save money and lives is well recognized; and their association with performance relies on the patterns of functionalities that are used by clinicians. However, the majority of research has investigated EHR adoption with a dichotomous dependent variable measuring EHR adoption or not. Other have studied individual EHR component or functionality. While these studies have contributed to understanding of EHR adoption, they provide an incomplete picture of hospital EHR capabilities and the study of EHR functionalities and associated configuration has only begun to be examined in detail, knowledge of which may generate important insights on actual practices of hospitals. It will assist healthcare executives to consider basing their decisions on empirically grounded knowledge rather than on purely normative discourses. Based on configurational approach, we use factor analysis and cluster analysis to uncover clusters of European public hospitals with similar patterns of EHR key functionalities made available to clinicians. As well we investigate the relationship between these patterns and hospital characteristics. Drawing on data from the European Hospital Survey, we empirically derive a 3-cluster solution, composed of three well-separated groups, from a data set of 711 European public hospitals. We find in addition that the three configurations exhibit great heterogeneity with regard to their polarity; that is the number and the nature of dominant categories of EHR key functionalities within each cluster. The three hospital profiles are: unipolar – hospitals with one dominant category of EHR functionalities (28% of the sample), tripolar - hospitals with three dominant categories of EHR functionalities (55%), and apolar - hospitals with no dominant category of EHR functionalities (17%), with tripolar being the largest and the most sophisticated. In particular, all the three clusters are distinct in terms of availability of key EHR functionalities namely, medical documentation, results viewing, and medication and prescription list functionalities available to their clinicians. The study also reveals the conditions under which these configuration occur. Our results provide an empirically and conceptually grounded taxonomy of European public hospitals with regard to EHR key functionalities.