title: Hospital electronic medical record enterprise application strategies: do they matter?
abstract: BACKGROUND
  Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance.
  
  
  OBJECTIVE
  This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses.
  
  
  METHODS
  A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics.
  
  
  RESULTS
  The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy.
  
  
  CONCLUSIONS
  This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward an enterprise application strategy.
authors: Department of Health Administration, PO Box 980203, Virginia Commonwealth University, Richmond, USA. fareedn@vcu.edu
authors: Naleef
authors: N
authors: Fareed
authors: Yasar A
authors: YA
authors: Ozcan
authors: Jonathan P
authors: JP
authors: DeShazo
mesh_terms: D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000458:organization & administration*; D006751:Hospital Information Systems / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States