Date of Award

Spring 4-1-2016

Document Type


Degree Name

Doctor of Science in Information Systems


Business and Information Systems

First Advisor

Surendra Sarnikar

Second Advisor

Cherie Noteboom

Third Advisor

Daniel Talley


Investments in Electronic medical records (EMR) is one of the largest components of overall health information technology investments. Examining the impact of EMR on quality of healthcare delivery is a topic of significant importance. This dissertation aims at exploring the relationship between the EMR capabilities and healthcare quality performance of hospitals. In particular, this study examines three important issues. First, the relationship between the synergy among different portfolios of EMR capabilities and quality of care at U.S. hospitals is studied. It also extends the analysis of EMR capabilities effects on quality of healthcare beyond the focus on the initial investment to examine how the assimilation and use of different EMR capabilities impact various healthcare quality measures. We used archival data to conduct a five-year (2008-2012) longitudinal study of a large panel of U.S. hospitals. Second, this study seeks to determine whether early adopters of advanced EMR capabilities (CPOE and physician documentation) were able to improve quality of healthcare, and finally, this research also answers the question of whether EMR capabilities adoption path impacts healthcare quality outcomes. Our results suggest that the synergy among full EMR capabilities portfolio is associated with better quality outcomes. Our results also suggest that the greater assimilation and use of EMR capabilities are also associated with improvement on only one quality outcomes measure. Further, the results highlight that early adopters of advanced EMR capabilities were able to improve quality outcomes relative to hospitals that were not early adopters. Furthermore, our results suggest that the sequence of EMR capabilities adoption does matter, and the findings empirically show improvement in quality outcomes when hospitals follow certain sequences of EMR capabilities adoption. We believe that this study has important implications for public policy focused on enhancing health IT investments in EMR capabilities and improving quality outcomes.