INVESTIGATING U.S. HOSPITALS’ USE OF COMMUNITY HIE NETWORKS: EFFICIENCY- AND LEGITIMACY- ORIENTED PERSPECTIVES
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Community Health Information Exchanges (HIE) have seen an increase in adoption just in the past five years, despite considerable state and federal funding since 2004. Prior research has shown, however, that merely adopting technology does not mean it is being used to carry out work. It is therefore important to investigate actual usage in hospitals. This study views the use of community HIE networks by U.S. hospitals from two theoretical lenses: transaction cost economics (TCE) and institutional theory. These two complementary lenses can provide a thorough account of usage behavior. A hospital-level structural model was developed to test the effects of efficiency- and legitimacy-oriented factors on the usage level of community HIE networks in U.S. hospitals, as defined by the two theoretical lenses. Primary data were collected from CEOs, CIOs, or COOs via a survey distributed to 2283 community hospitals across the U.S. In addition to primary data collected from the survey questionnaire, secondary data from the American Hospital Association (AHA) were employed as control variables and dependent variables. Both measurement validation and hypothesis testing were conducted using Smart PLS 3.2.8. Results indicate that legitimacy-oriented factors have significant effects, whereas efficiency-oriented factors don’t have significant effects in explaining post-adoption use of community HIE networks by these hospitals. The study makes three major contributions. First, it constitutes the first systematic test of the effect of institutional factors and use behavior of U.S. community HIE networks. Second, the study moves beyond the adoption theme to investigate post-adoption use behavior of U.S hospital on community HIE networks beyond the appearance of formal adoption in the new circumstance. Third, the study empirically demonstrates that not all legitimacy-oriented factors have effects on post-adoption use; finally, efficiency-oriented factors appear to have no influence in this sample.