Do Skill Mix and High Tech Matter for Hospitals' Competency in Adopting Electronic Health Records?

Abstract

Health workforce plays an important role in the adoption of electronic health records (EHRs). Hospitals have cited barriers around hiring a competent workforce to adopt EHRs. The literature does not adequately relate organizational and health workforce competency with EHR adoption, which makes it difficult to monitor and evaluate any programs targeting trying to improve this problem. In this study, we develop an index measuring hospitals' competency in adopting electronic health records (EHRs) using Item Response Theory. We test to what extent hospitals' skill mix and high tech capacity influence their competency. We use health IT data from Health Information and Management Systems Society (HIMSS) Analytics Database and workforce and high tech data from the Centers of Medicare and Medicaid Services (CMS) Provider of Services file. We found that hospitals with a larger share of registered nurses (RNs) had higher EHR competency, but environments with more high tech potentially compete for their attention and results in lower EHR competency. Technicians, therapists, and lower skilled nurses that interact with high tech apparently transfer their knowledge and skills into higher EHR competency. Future EHR adoption incentives should target lower competency hospitals with insufficient workforce and less technological capacity.