Journal of Medical Systems

, Volume 30, Issue 6, pp 429–438 | Cite as

Clinical Information System Availability and Use in Urban and Rural Hospitals

  • Marcia M. WardEmail author
  • Mirou Jaana
  • James A. Bahensky
  • Smruti Vartak
  • Douglas S. Wakefield
Original Paper


Clinical information systems (CIS) capture clinical data to support more efficient and effective decision making and clinical care delivery. Only a few estimates of CIS availability and use in hospitals are available nationally. The purpose of the current research is to examine differences in CIS availability and use between urban and rural hospitals. A survey addressing this purpose was completed by 74 (63.7%) of Iowa hospitals. Rural hospitals lag behind urban hospitals in terms of many CIS applications. More than 80% of the urban hospitals, but only between 30 and 40% of the rural hospitals, reported using computers to collect basic clinical information for potential use in an electronic medical record (EMR) and computerized provider order entry (CPOE) system. Comparison of CIS within one state’s urban and rural hospitals sheds light on variation in clinical support applications, decision support, and electronic medical record “readiness” in these settings.


Hospital information systems Decision support systems Clinical hospitals Rural medical records systems Computerized medical informatics 



Support for this work was provided by a grant from the Iowa Department Public Health and by grant HS015009 from the Agency for Healthcare Research and Quality.


  1. 1.
    Austin, C., and Boxerman, S., Information Systems for Healthcare Management, 6th ed, Health Administration Press, Chicago, 2003.Google Scholar
  2. 2.
    Hillstad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R., Can electronic health record systems transform health care? Potential health benefits, savings and costs. Health Aff. 24(5):1103–1117, 2005.CrossRefGoogle Scholar
  3. 3.
    Toole, J. The need for transformation, health care technology: Innovating clinical care through technology. A thought leadership project from Montgomery Research, Inc. Retrieved from 2003.Google Scholar
  4. 4.
    Miller, R. H. Physician’s use of electronic medical records: Barriers and solutions. Health Aff. 23(2):116–126, 2004.CrossRefGoogle Scholar
  5. 5.
    Vogel, L. Finding value from IT investments: Exploring the elusive ROI in healthcare. J. Healthc. Inf. Manage. 17(4): 20–28, 2003.Google Scholar
  6. 6.
    DHHS, United States Department of Health & Human Services; Office of the National Coordinator for Health Information Technology (ONC). Retrieved August, 2005 from Scholar
  7. 7.
    Friedman, B. A. Informating, not automating, the medical record. J. Med. Syst. 13(4):221–225, 1989.CrossRefGoogle Scholar
  8. 8.
    Kerr, E. A., McGlynn, E. A., and Damberg, C. Developing and using a clinical information system. In McGlyn, E. A., Damberg, C. L., Kerr, E. A., and Brook, R. H. (eds.), Health Information Systems: Designs Issues and Analytical Application, RAND Health Publications, Santa Monica, California, 141–187, 1998.Google Scholar
  9. 9.
    Burke, D. E., and Menachemi, N. Opening the black box: Measuring hospital information technology capability. Health Care Manage. Rev. 29(3):207–217, 2004.Google Scholar
  10. 10.
    Kelly, B. Clinical Information Systems: Perspective 2001. Retrieved December 26, 2002 from Scholar
  11. 11.
    Brooks, R. G., Manachemi, N., Burke, D., and Clawson, A. Patient safety-related information technology utilization in urban and rural hospitals. J. Med. Syst. 29(2):103–109, 2005.CrossRefGoogle Scholar
  12. 12.
    Burke, D. E., Wang, B. B. L., Wan, T. T. H., and Diana, M. L. Exploring hospitals’ adoption of information technology. J. Med. Syst. 26(4):349–355, 2002.CrossRefGoogle Scholar
  13. 13.
    Menachemi, N., Burke, D., Clawson, A., and Brooks, R. G. Information technologies in Florida’s rural hospitals: Does system affiliation matter? J. Rural Health 21(3): 263–268, 2005.CrossRefGoogle Scholar
  14. 14.
    Ohsfeldt, R., Ward, M. M., Schneider, J., Jaana, M., Miller, T., Lei, Y., and Wakefield, D. S. Implementation of computerized physician order entry systems in Iowa hospitals: Feasibility and financial impact. J. Am. Med. Inform. Assoc. 12(1): 20–27, 2005.CrossRefGoogle Scholar
  15. 15.
    Walston, S. L., Kimberly, J. R., and Burns, L. R. Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering. Med. Care Res. Rev. 58:194–228, 2001.Google Scholar
  16. 16.
    Paré, G., and Sicotte, C. Information technology capability in health care: An instrument validation study among Canadian hospitals. Int. Med. Inform. 63: 205–223, 2001.CrossRefGoogle Scholar
  17. 17.
    Jaana, M., Ward, M. M., Pare, G., and Wakefield, D. S. Clinical information technology in hospitals: A comparison between the state of Iowa and two provinces in Canada. Int. J. Med. Inform. 74: 719–731, 2005.CrossRefGoogle Scholar
  18. 18.
    American Hospital Association (AHA), Annual Survey Database, 2002.Google Scholar
  19. 19.
    Iowa Hospital Association (IHA), Profiles, 2002.Google Scholar
  20. 20.
    Health Care Financing Administration. Urban / Rural Reclassification (2001). Retrieved November 05, 2003 from Scholar
  21. 21.
    Reynolds, J., and Rabin, J. Maximizing IT in smaller hospitals. Retrieved September 4, 2005 from Scholar
  22. 22.
    Cushman, R. Series technology assessment for health care information technology. J. Am. Med. Inform. Assoc. 4:259–265, 1997.Google Scholar
  23. 23.
    Raghupathi, W., and Tan, J. Strategic uses of information technology in HC: A state of the art survey. Topics Health Inform. Manage. 20(1):1–15, 1999.Google Scholar
  24. 24.
    Chu, S. Part I-Clinical information systems: A fourth generation. Nurs. Manage. 24(10):59–60, 1993.Google Scholar
  25. 25.
    Truchaud, A., Le Neel, T., Brochard, H., Malvaux, S., Moyon, M., and Cazaubiel, M. New tools for laboratory design and management. Clin. Chem. 43(9):1709–1715, 1997.Google Scholar
  26. 26.
    PriceWaterhouseCoopers. Cost of caring: Key drivers of growth in spending on hospital care. Retrieved August, 2005 from Scholar
  27. 27.
    Levin, B. Enterprise PACS: Practical, Proven, and In Demand, HCT Project. A thought leadership project from Montgomery Research, Inc., 2003.Google Scholar
  28. 28.
    Serb, C. J., Haugh, R., Sarudi-Scalise, D., Carpenter, D., and Gearon, C. J. Special report: Information technology point and click. Hospital and Health Networks. Retrieved January 14, 2002, from Scholar
  29. 29.
    Healthcare Information and Management Systems Society. 14th annual HIMSS leadership survey: Healthcare CIO survey final report. Retrieved December 21, 2003 from Scholar
  30. 30.
    Turisco, F., and Metzger, J. Rural healthcare delivery: Connecting communities through technology. Manuscript prepared for California Healthcare Foundation by First Consulting Group. pp. 1–39, 2002.Google Scholar
  31. 31.
    Feied, C. F., Smith, M. S., Handler, J. A., and Kanhouwa, M. Emergency medicine can play a leadership role in enterprise-wide clinical information systems. Ann. Emerg. Med. 5(2):162–167, 2000.CrossRefGoogle Scholar
  32. 32.
    Blendon, R. J., DesRoches, C. M., Brodie, M., Benson, J. M., Rosen, A. B., Schneider, E., Altman, D. E., Zapper, K., Herrmann, M. J., and Steffenson, A. E. Views of practicing physicians and the public on medical errors. New Engl. J. Med. 347(24): 1933–1940, 2002.CrossRefGoogle Scholar
  33. 33.
    Metzger, J., and Fortin, J. Computerized physician order entry in community hospitals: Lessons from the field. Manuscript prepared for California Healthcare Foundation by First Consulting Group, pp. 1–52, 2003.Google Scholar
  34. 34.
    James, B. E-Health: Steps on the road to interoperability. Health Aff. W5: 26–30, 2005.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Marcia M. Ward
    • 1
    • 2
    Email author
  • Mirou Jaana
    • 3
  • James A. Bahensky
    • 1
  • Smruti Vartak
    • 1
  • Douglas S. Wakefield
    • 4
  1. 1.Department of Health Management and PolicyUniversity of IowaIowa CityUSA
  2. 2.Center for Research in the Implementation of Innovative Strategies in PracticeIowa City VA Medical CenterIowa CityUSA
  3. 3.Department of Health Management and PolicyAmerican University of BeirutBeirutLebanon
  4. 4.Department of Health Management and Informatics, Center for Health Care QualityUniversity of MissouriColumbiaMOUSA

Personalised recommendations