284833
Crossing or expanding the digital divide?: The transition from NPM to digital governance in for-profit and non-profit health care providers
Megan Schoor
,
Truman School of Public Affairs, University of Missouri-Columbia, Columbia, MO
Background: The Patient Protection and Affordable Care Act (PPACA) encourages electronic medical record (EMR) system adoption, as they potentially reduce administrative costs and medical errors, and consequently improve patient care. This cost-efficiency focus embraces New Public Management (NPM), a governance approach emphasizing marketization, decentralization, and accountability; however, EMRs require significant changes to organizational governance for successful implementation. Research shows that community health centers (CHCs) face barriers to EMR adoption, implying a digital divide amongst health care organizations. This research examines whether NPM strategies and office characteristics influence the transition to digital governance. Methods: Using data from the 2010 National Ambulatory Medical Care Survey (NAMCS), logistic regression was used to determine the likelihood of EMR and patient demographic system adoption among CHC and private physician practices (n= 1,052) based on indicators of NPM and office-level characteristics that signify important governance mechanisms and influential environmental factors. Results: NPM's influence varies depending on the digital governance strategy and office-level characteristics. CHC-owned offices had lower odds of using EMRs within their practices, but the interaction between being CHC-owned and having a larger percent of fee-for-service revenue increases the odds of EMR adoption. CHCs have lower odds of EMR adoption as compared to private physician practices, but have higher odds of having a computerized patient demographic system. Conclusion: Findings imply a digital divide between CHCs and private practices, alluding to the limited capacity of non-profits serving marginalized populations to adopt innovative governance strategies. NPM techniques and office-level characteristics potentially influence this movement towards technological innovation.
Learning Areas:
Implementation of health education strategies, interventions and programs
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Learning Objectives:
Identify whether any sector-level variation (private v. nonprofit) exists in the likelihood of adopting EMR and/or computerized patient demographic systems.
Assess the influence that greater fee-for-service patient revenue has on a health care organization’s decision to adopt digital governance strategies.
Keywords: Community Health Centers, Public Health Administration
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have conducted research and attended seminars on the PPACA's influence on the quality and cost of health care in the U.S. Among my specific research interests is the sector-level variation in organization capacity to implement the PPACA's guidelines and suggested improvements to physician practices. My previous research experience and public administration background in non-profit management provide a different perspective on the organization-level implications for how health services are delivered.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
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