Journal of Management Information Systems

Volume 40 Number 3 2023 pp. 840-882

Differential Impacts of Technology-Network Structures on Cost Efficiency: Knowledge Spillovers in Healthcare

Nwafor, Onyi, Ma, Xiao, Johnson, Norman A, Singh, Rahul, and Aron, Ravi


We examine how hospital cost efficiency can improve because of knowledge spillover effects, arising from the experiences of members of a healthcare system. We identify two types of functional technology networks—that we term repository-type and workflow-type networks—which are defined by the adoption patterns of different types of electronic health record (EHR) systems application functions by hospitals in a health system. Additionally, we examine how structural features of these two network types—namely, network centrality and interconnectedness—impact such knowledge spillover effects. By analyzing seven years of panel data for 1,420 U.S. hospitals across 216 health systems, and data obtained from surveys of healthcare experts, we found that greater centrality of nodes in repository-type networks enhances the influence of partners’ experiences on cost efficiency but has the opposite effect in workflow-type networks, while greater interconnectedness of workflow-type networks enhances the influence of partners’ experiences on cost efficiency. Interestingly, we found the opposite effect in repository-type networks, where greater interconnectedness diminishes the influence of partners’ experiences on cost efficiency. We discuss reasons for this surprising and counterintuitive finding. Overall, our results demonstrate that at least in healthcare settings where information technologies enable knowledge-sharing networks to be formed, benefits can accrue through knowledge spillover effects; moreover, variations across functional categories of technologies adopted in a network context can result in different technology-network structures with differential impacts on hospital cost efficiency because of their influence on knowledge spillover at both the hospital and system levels. Not only can these results explain mixed findings in the literature that has been dominated by a focus on cost efficiency outcomes dependent solely on the EHR adoption choices of individual hospitals, but they also provide the basis for guidelines for a network-based perspective of technology adoption. We discuss other possible settings to which our empirical findings can be reasonably generalized, including supply chain technologies and the Internet of Things.

Key words and phrases: Healthcare costs, knowledge networks, electronic health records, knowledge spillovers, knowledge transfer