Electronic Health Record (EHR) has the potential to transform the work required to create and deliver healthcare services. This has triggered large-scale adoption across hospitals. However, whether all hospitals obtain a similar effect from their EHR implementations remains an important question because there are significant differences differences in characteristics of hospitals adopting these systems. To examine differences in effects across hospitals, we examine whether the impacts of EHR applications are contingent on work domains, by assessing performance effects across hospitals with varying administrative scale and clinical complexity. Because EHRs constitute a suite of applications with different functionalities, examining the effects of different sets of applications is challenging due to nonlinear interdependencies between applications. Therefore, we use an archetype approach, identifying synergistic EHR (EHRSYN) archetype as an ideal portfolio—a conceptual anchor for a hospital’s EHR portfolio. We test contingencies by combining this technology archetype with the work domains—administrative scale and clinical complexity. We test our hypotheses using empirical data from 137 hospitals in California, hypothesizing the differences in effects of EHRs on financial, operational, and clinical performances across hospitals with different administrative scales (size) and clinical complexities (case-mix) of work. While hospitals gain the most by implementing a portfolio close to the EHRSYN archetype, our nuanced models reveal that the benefits of such portfolios increase for large hospitals and are greater for hospitals treating less complex cases. These findings underscore how variations in applications used and work domains demarcate boundaries related to the performance effects of EHRs. We present a detailed discussion of the theoretical contributions and practical implications of our findings.

电子健康记录（EHR）有潜力改变创建和提供医疗服务所需的工作。这触发了医院之间的大规模采用。但是，由于采用这些系统的医院在特性上存在显着差异，因此所有医院是否都从实施EHR中获得类似效果仍然是一个重要的问题。为了检查各医院之间效果的差异，我们通过评估具有不同管理规模和临床复杂性的各医院之间的绩效影响，来检查EHR应用程序的影响是否取决于工作领域。由于EHR构成了具有不同功能的一组应用程序，因此由于应用程序之间的非线性相互依赖关系，检查不同组应用程序的效果具有挑战性。因此，我们使用原型方法，将协同EHR（EHRSYN）原型确定为理想的组合-医院EHR组合的概念锚。我们通过将此技术原型与工作领域（管理规模和临床复杂性）相结合来测试意外事件。我们使用来自加利福尼亚州137家医院的经验数据来检验我们的假设，假设EHR对不同工作规模（规模）和临床复杂性（案例混合）的医院在财务，运营和临床表现方面的影响存在差异。尽管医院通过实施类似于EHRSYN原型的组合获得最大收益，但我们细致入微的模型显示，此类组合的收益对于大型医院而言增加，而对于处理较不复杂病例的医院则更大。这些发现强调了所使用的应用程序和工作域中的变化如何划定与EHR的性能影响有关的边界。我们对我们的发现的理论贡献和实践意义进行了详细的讨论。