The Impact of Electronic Medical Records Systems on Healthcare Subunit Performance: A Dynamic Capabilities Study

Abstract

This thesis focuses on the impact of electronic medical records (EMR) systems on healthcare subunit performance. EMR systems are a relatively new artifact in the healthcare industry and have come under a great deal of attention lately, seen as a way of reducing healthcare costs and improving healthcare quality. We have taken a dynamic capabilities perspective for this research. We developed a model that suggests that two dynamic capabilities: process management and change management, will positively impact usage of EMR systems, and that EMR use is the key driver of operational performance at the subunit level. We tested our theory with a sequential mixed method approach. Our unit of analysis was hospital emergency clinicians. Our quantitative data collection method was through the use of an online survey of mainly nurse and nurse managers. Survey data was analyzed using structural equation modeling. Our qualitative data collection method was through the use of qualitative interviews with emergency department stakeholders. The interviews were conducted to obtain additional insight into the issues surrounding implementation and use of EMR systems and to help explain our quantitative results. We found that process management and pre-implementation change management positively impact EMR use, and that EMR use positively impacts clinician related performance. Post-implementation change management was found to have a negative effect on EMR use. Finally, we found that process management had a direct positive effect on patient-related performance and EMR use had an indirect positive effect on patient-related performance, mediated by clinician-related performance. iii Acknowledgements This thesis would not have been possible without the support of my family. I am thankful to my wife Miriam and my children, Justin and Jenna. Their patience and encouragement through this long and arduous process has been greatly appreciated. I am also very grateful for the tremendous amount of help, support, advice and encouragement that I have received from my friends and colleagues at Clarkson University. I am also thankful for the advice and contacts I have made through friends and family who are members of the healthcare community, and the new friendships I have made in the process of this research.