Investigating U.S. Hospitals' Use of Community HIE Platforms: An Institutional Perspective

There has been significant growth in the adoption of community HIE platforms by U.S. hospitals since 2012. However, research on technology adoption shows that simply adopting a technology does not mean it is actually used for everyday work transactions. While there may be many reasons for non-usage, we address competitive concerns as a potential barrier to hospital participation in community HIE networks. We attempt to resolve the paradox between competitive concerns and actual use behavior of U.S. hospitals from an institutional perspective. We believe that pressures from the institutional environment play a role in the decision of participating in community HIE networks because hospitals are compelled to adapt themselves to the wider social structure in addition to considerations of technical efficiency. A structural model was developed at the hospital level to test the effects of three institutional pressures on the usage levels of community HIE platforms. Our findings indicated that the effects of institutional pressures will extend from the adoption domain to the use domain. Hospitals are driven to improve their use of community HIE platforms by selected organizations in the organizational field.