THE APPLICATION OF QUANTITATIVE METHODS IN THE ADOPTION OF CLOUD COMPUTING WITHIN A FRAMEWORK OF UNIFIED TECHNOLOGY ACCEPTANCE THEORY: A COMPARATIVE ANALYSIS OF U.S. HOSPITALSntitled Item

This study aims to predict the environmental, organizational, and managerial factors that determine the adoption of cloud computing in U.S. healthcare delivery systems. The premise of the analysis is that several internal and external factors determine a health provider’s transition to cloud computing. The U.S. government has funded healthcare providers through HITECH (Health Information Technology for Economic and Clinical Health) to implement electronic health records (EHR) which is considered as an important first step in transitioning to cloud computing. This study investigated whether there is a significant difference between hospitals and providers that received HITECH funding to enhance their EHR infrastructure and those that did not in terms of their external environmental complexities, internal organizational structure, and quality of healthcare services they provide. A stratified random sample was applied to select a cohort of 3,385 hospitals from the American Hospital Association (AHA) 2022 roster for the period 2018- 2021 to test the study hypothesis. The sampled hospitals were linked with claim, administrative, cost, and ICD-10 clinical data files to capture variables of interest repeatedly over the study period. The analysis modeled for selected external (location, market concentration as measured by Herfindahl Index), internal (number and composition of staff – physicians, nurses, technicians, etc.) demographic, clinical and financial factors. Quantitative methods such as generalized estimating equations (GEE), logistic regression, and generalized linear mixed model (GLMM) were applied within the framework of unified technology acceptance theory (UTAT), accounting for both discrete and continuous response variables while modeling for possible between-subject heterogeneity and within-subject correlations. The analysis is based on publicly available data sources that are systematically linked to address the research questions. The portion of the HITECH funding that is applied for cloud computing is calculated from the hospital’s EHR funding. This is one of the very few longitudinal time series studies of cloud computing in healthcare since almost all previous studies on American hospitals are cross-sectional. The findings of this study show statistically significant differences between hospitals that received government funding in terms of internal organizational structure, environmental complexity, and quality of healthcare provided. The analysis identified management and quality metrics that help to gauge continuously changing organizational needs and identify emerging trends. This study proposes specific topics that future researchers can consider promoting a successful implementation of cloud computing.