ABSTRACT

We examine how hospital cost efficiency can improve because of knowledge spillover effects, arising from the experiences of members of a healthcare system. We identify two types of functional technology networks—that we term repository-type and workflow-type networks—which are defined by the adoption patterns of different types of electronic health record (EHR) systems application functions by hospitals in a health system. Additionally, we examine how structural features of these two network types—namely, network centrality and interconnectedness—impact such knowledge spillover effects. By analyzing seven years of panel data for 1,420 U.S. hospitals across 216 health systems, and data obtained from surveys of healthcare experts, we found that greater centrality of nodes in repository-type networks enhances the influence of partners’ experiences on cost efficiency but has the opposite effect in workflow-type networks, while greater interconnectedness of workflow-type networks enhances the influence of partners’ experiences on cost efficiency. Interestingly, we found the opposite effect in repository-type networks, where greater interconnectedness diminishes the influence of partners’ experiences on cost efficiency. We discuss reasons for this surprising and counterintuitive finding. Overall, our results demonstrate that at least in healthcare settings where information technologies enable knowledge-sharing networks to be formed, benefits can accrue through knowledge spillover effects; moreover, variations across functional categories of technologies adopted in a network context can result in different technology-network structures with differential impacts on hospital cost efficiency because of their influence on knowledge spillover at both the hospital and system levels. Not only can these results explain mixed findings in the literature that has been dominated by a focus on cost efficiency outcomes dependent solely on the EHR adoption choices of individual hospitals, but they also provide the basis for guidelines for a network-based perspective of technology adoption. We discuss other possible settings to which our empirical findings can be reasonably generalized, including supply chain technologies and the Internet of Things.

摘要

我们研究了医疗保健系统成员的经验所产生的知识溢出效应如何提高医院成本效率。我们确定了两种类型的功能技术网络——我们称之为存储库型和工作流型网络——它们是由卫生系统中的医院对不同类型的电子健康记录（EHR）系统应用功能的采用模式来定义的。此外，我们还研究了这两种网络类型的结构特征（即网络中心性和互联性）如何影响这种知识溢出效应。通过分析 216 个卫生系统 1,420 家美国医院 7 年的面板数据以及从医疗保健专家调查中获得的数据，我们发现，存储库型网络中节点的中心性越高，合作伙伴的经验对成本效率的影响越大，但在工作流型网络中则相反，而工作流型网络的互联程度越高，合作伙伴的经验对成本效率的影响越大效率。有趣的是，我们在存储库型网络中发现了相反的效果，其中更大的互联性减少了合作伙伴的经验对成本效率的影响。我们讨论这一令人惊讶且违反直觉的发现的原因。总体而言，我们的结果表明，至少在信息技术能够形成知识共享网络的医疗保健环境中，可以通过知识溢出效应产生效益；而且，网络环境中采用的技术功能类别的差异可能会导致不同的技术网络结构，对医院成本效率产生不同的影响，因为它们对医院和系统层面的知识溢出都有影响。这些结果不仅可以解释文献中的混合结果，这些结果主要集中于仅依赖于各个医院的 EHR 采用选择的成本效率结果，而且它们还为基于网络的技术采用视角提供了指导方针的基础。我们讨论了我们的实证研究结果可以合理推广的其他可能的环境，包括供应链技术和物联网。