Advisor(s)

Larry Hearld

Committee Member(s)

Jeff Szychowski
Nancy Borkowski
Ria Hearld

Document Type

Dissertation

Date of Award

6-18-2026

Degree Name

Doctor of Science in Administration Health Services (DSc)

School

School of Health Professions

Department

Administration/Health Services

Abstract

Administrative burden associated with health information exchange represents a persistent challenge for U.S. hospitals, contributing to provider burnout and operational inefficiency. This study examined whether interorganizational linkages, specifically hospital system affiliation, participation in Accountable Care Organizations (ACOs), and participation in Health Information Exchanges (HIEs), are associated with perceived barriers to electronic health information exchange. Guided by the Relational View, linkages were conceptualized as potential conduits for shared assets, knowledge-sharing routines, and complementary capabilities that might reduce barriers to exchange. Data from 2018–2023 were drawn from the American Hospital Association Annual Survey and IT Supplement, merged with community-level measures from the Area Health Resource File. Poisson regression with cluster-robust standard errors was used to examine how interorganizational linkages relate to barriers in sending and receiving health information. The final analytic sample consisted of 15,520 hospital-year observations representing 4,916 unique hospitals. Contrary to hypotheses, all three linkages were associated with significantly more barriers in the full sample. Subgroup analyses revealed that these associations were concentrated among small and medium hospitals, while large hospitals (300–499 beds) showed no significant linkage effects. Temporal analyses revealed that ACO participation was associated with fewer receiving barriers in 2020–2022, the only instance in which a linkage was associated with reduced barriers. These findings suggest that linkage participation generates coordination demands before relational returns materialize, particularly among resource-constrained hospitals. Policymakers and administrators should evaluate not just participation in interorganizational linkages but organizational capacity to absorb the demands that participation brings. Additionally, policymakers should seek to rationalize existing and new policies to streamline burden relative to intended outcome goals.

Keywords

administrative burden;health information exchange;hospital size;interorganizational linkages;Poisson regression;Relational View

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