تاثیر سرمایه گذاری های فناوری اطلاعات سلامت بر عملکرد مالی بیمارستان و بهره وری Do health information technology investments impact hospital financial performance and productivity?

1. Introduction The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, promotes the adoption and use of Health Information Technology (HIT) by providing significant financial incentives and penalties to healthcare organizations. With large investments in information technology such as Electronic Health Record (EHR) systems, questions related to financial and productive payoffs become increasingly important. EHRs meet the goals of integrating patient medical history with current treatment thereby facilitating improved quality of care and increased productivity, but are expensive for organizations, potentially impacting financial performance and productivity (Kohli and Tan, 2016; Devaraj and Kohli, 2000; Li and Collier, 2000). Since the enactment of HITECH, the adoption rate of EHR systems has increased significantly.1 As of 2015, 84% of hospitals report adopting at least a basic EHR system, representing a nine-fold increase since 2008 (Henry et al., 2016). To encourage EHR adoption, the Centers for Medicare & Medicaid Services (CMS) provides incentive payments to hospitals that successfully demonstrate Meaningful Use of EHR technology. The meaningful use initiative supports several health care goals including the improvement of quality, safety, and efficiency; the reduction of health disparities; the engagement of patients and families in care decisions; the improvement of public health; and the ascertainment of privacy and security of patient health information. Ultimately, it is hoped that Meaningful Use compliance will result in better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals, and more robust research data on health systems (HealthIT.gov, 2015). Introduced in three stages, Meaningful Use Stage2 1 focused on data capture and sharing from 2011 to 2014. Stage 2 focuses on advance clinical processes from 2015 to 2017, and Stage 3 focuses on improved outcomes after 2017 (Holland, 2015). Meaningful Use sets specific objectives that hospitals must achieve to qualify for CMS incentive payments. For example, to meet Meaningful Use Stage 2 requirements for 2015 to 2017, EHR systems should support objectives such as protecting electronic health information and using clinical decision support systems to improve performance (CMS, 2016). In addition to CMS Meaningful use standards, HITECH also requires EHR systems be interconnected to improve the quality of health care. Because of these issues and requirements, Accounting Information Systems researchers continue to call for an expansion of healthcare research to include business process influences (Fichman et al., 2011). In theory, IT investment can improve healthcare service efficiency and generate positive financial returns (Menon et al., 2000). However, the expected efficiencies and quality improvements remain elusive. Adding to these concerns, previous research used organizational data developed prior to the HITECH Act and its financial incentives. With the rapid adoption of EHRs, an examination of contemporary IT environments is required.