Value Implications of Sourcing Electronic Health Records: The Role of Physician Practice Integration

Abstract

Should hospitals source electronic health records (EHR) systems from a single vendor or multiple vendors to deliver high-value care? We study hospitals’ EHR sourcing strategies based on their degree of integration with physician practices and its impact on the value of healthcare delivered. We propose a novel framework to define healthcare value as the extent to which a hospital effectively expends clinical resources to deliver services that improve patient outcomes. Drawing on modular systems and transaction cost economics theories, we propose a moderated-mediation model that explores the pathways through which EHR sourcing strategies can create value in healthcare. We test our research hypotheses on a large, longitudinal sample of U.S. hospitals and observe that hospitals with EHR configurations closer to single sourcing strategies exhibit greater health information sharing compared with hospitals with multisourced EHR systems. Furthermore, we find that hospital-physician practice integration moderates the impact of single sourcing on health information sharing, which in turn, improves value. Specifically, tighter integration between hospitals and physician practices can create greater value if it is aligned with hospitals’ EHR sourcing strategies. As the healthcare industry moves toward value-based payment reform, our findings provide a useful roadmap to practitioners and policy makers to improve the performance of hospitals and healthcare providers. History: Rajiv Kohli, Senior Editor; Sunil Wattal, Associate Editor. Funding: I.R. Bardhan thanks the Foster Parker Centennial Professorship and the Dean’s Research Excellence Grant at the McCombs School of Business at UT Austin for generous financial support. C. Bao thanks the Spears Fellowship at Oklahoma State University for financial support. Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2022.1183 .