EHR application portfolio and hospital performance: Effects across hospitals with varying administrative scale and clinical complexity

Electronic Health Record (EHR) has the potential to transform the work required to create and deliver healthcare services. This has triggered large-scale adoption across hospitals. However, whether all hospitals obtain a similar effect from their EHR implementations remains an important question because there are significant differences differences in characteristics of hospitals adopting these systems. To examine differences in effects across hospitals, we examine whether the impacts of EHR applications are contingent on work domains, by assessing performance effects across hospitals with varying administrative scale and clinical complexity. Because EHRs constitute a suite of applications with different functionalities, examining the effects of different sets of applications is challenging due to nonlinear interdependencies between applications. Therefore, we use an archetype approach, identifying synergistic EHR (EHRSYN) archetype as an ideal portfolio-a conceptual anchor for a hospital's EHR portfolio. We test contingencies by combining this technology archetype with the work domains-administrative scale and clinical complexity. We test our hypotheses using empirical data from 137 hospitals in California, hypothesizing the differences in effects of EHRs on financial, operational, and clinical performances across hospitals with different administrative scales (size) and clinical complexities (case-mix) of work. While hospitals gain the most by implementing a portfolio close to the EHRSYN archetype, our nuanced models reveal that the benefits of such portfolios increase for large hospitals and are greater for hospitals treating less complex cases. These findings underscore how variations in applications used and work domains demarcate boundaries related to the performance effects of EHRs. We present a detailed discussion of the theoretical contributions and practical implications of our findings.