Levels of EMR Adoption in U.S. Hospitals: An Empirical Examination of Absorptive Capacity, Institutional Pressures, Top Management Beliefs, and Participation Venugopal Gopalakrishna-Remani 1 & Robert Paul Jones 1 & Kerri M. Camp 1 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Technology adoption literature generally focuses on behavioral and structural changes necessary for successful adoption. Little explored in that literature is the factors impacting the level of adoption which will be achieved within the organization. This healthcare industry research demonstrates that higher levels of technology adoption in organizations require the influences of both internal absorptive capabilities and external institutional pressures impacting the organization. We surveyed U.S. healthcare employees to assess top management beliefs, top management participation, absorptive capacity, institutional pressures, and level of electronic medical records (EMR) adoption in clinics and hospitals. Our results indicate no direct influence of mimetic and coercive pressures on the level of EMR adoption. Normative and mimetic pressures indirectly influence EMR adoption level through top management participation. Absorptive capacity enhances top management beliefs and participation associated with EMR adoption process, resulting in higher levels of EMR adoption in U.S. hospitals. Keywords Top management beliefs . Absorptivecapacity . Top management participation . Institutional pressures . Level of EMR adoption 1 Introduction The Health Information Technology for Economic and Clinical Health (HITECH) Act portion of the American Reinvestment and Recovery Act (ARRA) of 2009 has applied considerable pressure on most healthcare organizations in the U.S. to adopt electronic medical records (EMR). The stimulus law supplies payments for providers who demonstrate reaching the Bmeaningful use^ standard of EMR adoption. An EMR created in a hospital and ambulatory environment serves as the legal record which provides source data for elec- tronic health records (EHR) designed to improve the quality and efficiency of patient care (Garets and Davis 2006). Higher levels of EMR adoption play an important role in integrating patient-specific recommendations and medical tasks as well as determining the most optimal treatment solutions. The higher levels of integration and evaluation may ultimately help in establishing a knowledge-based decision support that im- proves medical quality (Yang et al. 2012). As a result, signif- icant scholarly effort identifies factors which contribute to successful EMR adoption (Ash and Bates 2005; Dwivedi et al. 2015; Ford et al. 2006). In a recent study, 33% of the U.S. university psychology clinics use an EMR system and another 46% are planning to adopt, suggesting a wide varia- tion in adoption of EMR technology within this clinic popu- lation (Cellucci et al. 2015). Another study conducted on in- dependent hospitals in the U.S. states that adoption rates for all independent hospitals grew from 48% in 2008 to 77% by 2011 (Dranove et al. 2015). In 2012, EMR adoption rates were significantly higher for practices in rural areas (56%) versus those in urban areas (49%) (Whitacre 2015). Despite the known benefits of EMR adoption, the present rate and level of adoption has increased significantly since 2011, yet almost 25% of clinics still do not utilize even a basic EHR system (Charles et al. 2015), creating an interesting re- search question both in theory and practice. Recent research finds that even the removal of technical, financial, and legal barriers are not sufficient to ensure that the anticipated benefits of EMR adoption will be realized (Boonstra and Broekhuis 2010). Organizational and change processes mediate the main six categories of EMR adoption barriers namely; * Venugopal Gopalakrishna-Remani venugopal@uttyler.edu 1 Soules College of Business, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799, USA Information Systems Frontiers https://doi.org/10.1007/s10796-018-9836-9