title: Environmental market factors associated with electronic health record adoption among cancer hospitals.
abstract: Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care.
  
  
  
  The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals.
  
  
  
  Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited.
  
  
  
  In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals.
  
  
  
  A greater understanding of the environment's relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities' respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.
authors.affiliation: Will L. Tarver, DrPH, MLIS, is Postdoctoral Fellow, Training in Research for Behavioral Oncology and Cancer Control Program, Indiana University, and Postdoctoral Fellow, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana. E-mail: wltarver@iu.edu. Nir Menachemi, PhD, MPH, is Professor and Chair, Health Policy and Management, Fairbanks School of Public Health, Indiana University, and Affiliated Scientist, Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana.
authors.forename: Will L
authors.initials: WL
authors.lastname: Tarver
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008490:Medical Informatics; D006278:Medicare / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States