Skip to main content
Log in

Innovative Power of Health Care Organisations Affects IT Adoption: A bi-National Health IT Benchmark Comparing Austria and Germany

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Multinational health IT benchmarks foster cross-country learning and have been employed at various levels, e.g. OECD and Nordic countries. A bi-national benchmark study conducted in 2007 revealed a significantly higher adoption of health IT in Austria compared to Germany, two countries with comparable healthcare systems. We now investigated whether these differences still persisted. We further studied whether these differences were associated with hospital intrinsic factors, i.e. the innovative power of the organisation and hospital demographics. We thus performed a survey to measure the “perceived IT availability” and the “innovative power of the hospital” of 464 German and 70 Austrian hospitals. The survey was based on a questionnaire with 52 items and was given to the directors of nursing in 2013/2014. Our findings confirmed a significantly greater IT availability in Austria than in Germany. This was visible in the aggregated IT adoption composite score “IT function” as well as in the IT adoption for the individual functions “nursing documentation” (OR = 5.98), “intensive care unit (ICU) documentation” (OR = 2.49), “medication administration documentation” (OR = 2.48), “electronic archive” (OR = 2.27) and “medication” (OR = 2.16). “Innovative power” was the strongest factor to explain the variance of the composite score “IT function”. It was effective in hospitals of both countries but significantly more effective in Austria than in Germany. “Hospital size” and “hospital system affiliation” were also significantly associated with the composite score “IT function”, but they did not differ between the countries. These findings can be partly associated with the national characteristics. Indicators point to a more favourable financial situation in Austrian hospitals; we thus argue that Austrian hospitals may possess a larger degree of financial freedom to be innovative and to act accordingly. This study is the first to empirically demonstrate the effect of “innovative power” in hospitals on health IT adoption in a bi-national health IT benchmark. We recommend directly including the financial situation into future regression models. On a political level, measures to stimulate the “innovative power” of hospitals should be considered to increase the digitalisation of healthcare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Notes

  1. The entire questionnaire comprised 52 questions. Only results related to the research questions are presented in this paper.

  2. The German population of hospitals was constitued by those hospitals that had to deliver a quality report.

  3. This descriptor was originally called “function“[26]. For the sake of clarity we changed it to “IT function”.

  4. These frequency distributions relate to the data without “no response” answers, which had been coded as missing values. These frequencies therefore differ from the ones published in the IT Report Healthcare [23], where the distributions of all responses are shown.

References

  1. Ludwick, D. A., and Doucette, J., Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries: lessons learned from health information systems implementation experience in seven countries. Int. J. Med. Inform. [Internet] 78(1):22–31, 2009. doi:10.1016/j.ijmedinf.2008.06.005.

    Article  CAS  Google Scholar 

  2. OECD. OECD Guide to Measuring ICTs in the Health Sector [cited 2016 Apr 7]. Available from: http://www.oecd.org/health/health-systems/Draft-oecd-guide-to-measuring-icts-in-the-health-sector.pdf.

  3. European Comission. European hospital survey: Benchmarking deployment of e-health services (2012-2013) : final report. EUR, Scientific and technical research series, Vol 26359. Luxembourg: Publications Office; 2014. 1 online resource [292].

  4. Adler-Milstein, J., Ronchi, E., Cohen, G. R., Winn, L. A. P., and Jha, A. K., Benchmarking health IT among OECD countries: better data for better policy. J. Am. Med. Inform. Assoc. [Internet] 21(1):111–6, 2014. doi:10.1136/amiajnl-2013-001710.

    Article  Google Scholar 

  5. Lapão, L. V., The challenge of benchmarking health systems: is ICT innovation capacity more systemic than organizational dependent? Isr. J. Health Policy Res. [Internet] 4(1):41, 2015. doi:10.1186/s13584-015-0036-5.

    Article  Google Scholar 

  6. Hyppönen, H., Kangas, M., Surname, N., Reponen, J., Koch, S., and Surname, A. et al. Nordic eHealth benchmarking: Nordisk. Ministerråd., 2015.

  7. Hübner, U., Ammenwerth, E., Flemming, D., Schaubmayr, C., and Sellemann, B., IT adoption of clinical information systems in Austrian and German hospitals: results of a comparative survey with a focus on nursing. BMC Med. Inform. Decis. Mak. [Internet] 10(1):8, 2010. doi:10.1186/1472-6947-10-8.

    Article  Google Scholar 

  8. Wörz, M., and Busse, R., Analysing the impact of health-care system change in the EU member states--Germany. Health Econ. [Internet] 14(Suppl 1):S133–49, 2005. doi:10.1002/hec.1032.

    Article  Google Scholar 

  9. Sommersguter-Reichmann, M., and Stepan, A., The interplay between regulation and efficiency: evidence from the Austrian hospital inpatient sector. Socio-Econ. Plan. Sci. [Internet] 52:10–21, 2015. doi:10.1016/j.seps.2015.09.001.

    Article  Google Scholar 

  10. Wittie, M., Ngo-Metzger, Q., Lebrun-Harris, L., Shi, L., and Nair, S., Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers. J Healthc. Qual. [Internet] 38(1):42–51, 2016. doi:10.1111/jhq.12067.

    Article  Google Scholar 

  11. Adler-Milstein, J., DesRoches, C. M., Furukawa, M. F., Worzala, C., Charles, D., Kralovec, P., et al., More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. Health Aff. (Millwood) [Internet] 33(9):1664–71, 2014. doi:10.1377/hlthaff.2014.0453.

    Article  Google Scholar 

  12. Tsiknakis, M., and Kouroubali, A., Organizational factors affecting successful adoption of innovative eHealth services: a case study employing the FITT framework. Int. J. Med. Inform. [Internet] 78(1):39–52, 2009. doi:10.1016/j.ijmedinf.2008.07.001.

    Article  Google Scholar 

  13. Lewis, W., Agarwal, R., and Sambamurthy, V., Sources of influence on beliefs about information technology use: an empirical study of knowledge workers. MIS Quart. [Internet] 27(4):657–78, 2003.

    Google Scholar 

  14. DesRoches, C. M., Charles, D., Furukawa, M. F., Joshi, M. S., Kralovec, P., Mostashari, F., et al., Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Aff. (Millwood) [Internet] 32(8):1478–85, 2013. doi:10.1377/hlthaff.2013.0308.

    Article  Google Scholar 

  15. Liebe, J., Egbert, N., Frey, A., and Hübner, U., Characteristics of German hospitals adopting health IT systems - results from an empirical study. Stud. Health. Technol. Inform. [Internet] 169:335–8, 2011.

    Google Scholar 

  16. Hikmet, N., Bhattacherjee, A., Menachemi, N., Kayhan, V. O., and Brooks, R. G., The role of organizational factors in the adoption of healthcare information technology in Florida hospitals. Health Care Manag. Sci. [Internet] 11(1):1–9, 2008.

    Article  Google Scholar 

  17. Amarasingham, R., Diener-West, M., Plantinga, L., Cunningham, A. C., Gaskin, D. J., and Powe, N. R., Hospital characteristics associated with highly automated and usable clinical information systems in Texas, United States. BMC Med. Inform. Decis. Mak. [Internet] 8:39, 2008. doi:10.1186/1472-6947-8-39.

    Article  Google Scholar 

  18. McCullough, J. S., The adoption of hospital information systems. Health Econ. [Internet] 17(5):649–64, 2008. doi:10.1002/hec.1283.

    Article  Google Scholar 

  19. OECD. Demography: OECD Publishing; 2014.

  20. OECD. Health at a Glance 2015: OECD Publishing; 2015.

  21. Liebe, J., Hüsers, J., and Hübner, U., Investigating the roots of successful IT adoption processes - an empirical study exploring the shared awareness-knowledge of Directors of Nursing and Chief Information Officers. BMC Med. Inform. Decis. Mak. [Internet] 16(1):10, 2016. doi:10.1186/s12911-016-0244-0.

    Article  CAS  Google Scholar 

  22. Fernando, J., and Dawson, L., The natural hospital environment: a socio-technical-material perspective. Int. J. Med. Inform. [Internet] 83(2):140–58, 2014. doi:10.1016/j.ijmedinf.2013.10.008.

    Article  Google Scholar 

  23. Hübner, U., Liebe, J.D., Hüsers, J., Thye, J., Egbert, N., and Ammenwerth, E. et al., IT-Report Gesundheitswesen: Pflege im Informationszeitalter, 2015.

  24. Liebe, J. D., Hübner, U., Straede, M. C., and Thye, J., Developing a workflow composite score to measure clinical information logistics. a top-down approach. Meth. Inf. Med. [Internet] 54(5):424–33, 2015. doi:10.3414/ME14-02-0025.

    Article  CAS  Google Scholar 

  25. Sabes-Figuera, R., Maghiros, I., and Abadie, F., European hospital survey. JRC scientific and policy reports, Vol 26358. Luxembourg: Publ. Off. Europ. Union, 2013. Online-Ressource (.

  26. Zailani, S., Gilani, M.S., Nikbin, D., and Iranmanesh, M., Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J. Med. Syst. [Internet], 38(9), 2014. doi: 10.1007/s10916-014-0111-4.

  27. Song, D., Li, D., and Qiu, L., The relationship between CIO’s presence in the top management team and IT’s contribution to corporate innovation: an empirical study. Front. Bus. Res. Chin. [Internet] 4(4):685–701, 2010. doi:10.1007/s11782-010-0116-x.

    Article  Google Scholar 

  28. Neubauer, G., The economic future of german hospitals. Gesundh ökon Qual manag. [Internet] 19(01):26–35, 2014. doi:10.1055/s-0033-1356449.

    Article  Google Scholar 

  29. Mair, F. S., May, C., O'Donnell, C., Finch, T., Sullivan, F., and Murray, E., Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull. World Health Organ. [Internet] 90(5):357–64, 2012. doi:10.2471/BLT.11.099424.

    Article  Google Scholar 

  30. Cresswell, K., and Sheikh, A., Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J. Med. Inform. [Internet] 82(5):e73–e86, 2013. doi:10.1016/j.ijmedinf.2012.10.007.

    Article  Google Scholar 

  31. OECD. Health at a glance 2015 [Internet]. doi: 10.1787/health_glance-2015-en.

  32. Gesundheits- und Krankenpflegegesetz: GuKG, 1997.

  33. Bundesministerium für Gesundheit. Krankenhausfinanzierungsreformgesetz: KHRG, 2009.

  34. Jones, S. S., Rudin, R. S., Perry, T., and Shekelle, P. G., Health information technology: an updated systematic review with a focus on meaningful use. Ann. Intern. Med. [Internet] 160(1):48–54, 2014. doi:10.7326/M13-1531.

    Google Scholar 

  35. Sydow, J., and Schreyögg, G., Self-reinforcing processes in and among organizations. New York: Palgrave Macmillan; 2013. 1 online resource.

  36. Hoerbst, A., Hackl, W. O., Blomer, R., and Ammenwerth, E., The status of IT service management in health care - ITIL® in selected European countries. BMC Med. Inform. Decis. Mak. [Internet] 11(1):76, 2011. doi:10.1186/1472-6947-11-76.

    Article  Google Scholar 

  37. Bush, M., Lederer, A. L., Li, X., Palmisano, J., and Rao, S., The alignment of information systems with organizational objectives and strategies in health care. Int. J. Med. Inform. [Internet] 78(7):446–56, 2009. doi:10.1016/j.ijmedinf.2009.02.004.

    Article  Google Scholar 

  38. Hübner, U., What are complex ehealth innovations and how do you measure them? position paper. Meth. Inf. Med. [Internet] 54(4):319–27, 2015. doi:10.3414/ME14-05-0001.

    Article  Google Scholar 

  39. Höfler, M., Pfister, H., Lieb, R., and Wittchen, H. U., The use of weights to account for non-response and drop-out. Soc. Psychiatr. Psychiatr. Epidemiol. 40(4):291–9, 2005.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ursula Hübner.

Additional information

This article is part of the Topical Collection on Systems-Level Quality Improvement

Appendix

Appendix

Table 4 Questionnaire
Table 5 Comparison of samples and populations
Table 6 Multiple linear regression model on “IT function” sub-score
Table 7 Adjusted odds ratios for all IT functions

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hüsers, J., Hübner, U., Esdar, M. et al. Innovative Power of Health Care Organisations Affects IT Adoption: A bi-National Health IT Benchmark Comparing Austria and Germany. J Med Syst 41, 33 (2017). https://doi.org/10.1007/s10916-016-0671-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10916-016-0671-6

Keywords

Navigation