Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 12, 2026
Date Accepted: Jul 30, 2026
Impact of Digitalization on Performance of Dutch Hospitals: A Longitudinal Quantitative Study
ABSTRACT
Background:
Hospitals continue to invest heavily to increase their level of digitalization. While ad-vanced digital maturity is assumed to improve hospital performance, empirical evidence remains mixed. This tension is mirrored by the productivity paradox of IT, whereby in-vestments in digital technologies do not consistently translate into observable perfor-mance gains.
Objective:
This study aims to examine the relation between the HIMSS Electronic Medical Record Adoption Model (EMRAM) score and hospital’s financial, operational, and workforce-related indicators.
Methods:
This longitudinal study used an annual report data of Dutch hospitals from 2017 to 2023. Digital maturity was measured using HIMSS EMRAM certification and operational-ized dichotomously (Stages 6–7 vs ≤5). Outcome measures were financial (profit mar-gins, Return on Assets, Asset-turnover ratio, and personnel-expense ratio), operational (Length of Stay, Number of patients treated), and workforce (Absenteeism) perfor-mance indicators. Linear mixed-effects models were estimated while controlling for hospital size, teaching status, staff-to-patient ratio, time trends, and COVID-19 effects.
Results:
Across 518 hospital-year observations, advanced digital maturity was not significantly associated with improvements in financial performance, length of stay, or absenteeism. Hospitals with higher digital maturity initially appeared to treat more patients. However, this association was no longer statistically significant after correction for multiple tests.
Conclusions:
In a highly digitalized health system with near-universal electronic health record adop-tion, advanced technical digital maturity alone was not associated with measurable im-provements in aggregated hospital-level financial, operational, or workforce perfor-mance. These findings provide longitudinal empirical support for the IT productivity paradox in hospital digitalization, suggesting that technical maturity is a necessary but insufficient condition for performance gains.
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