Applying institutional theory to the adoption of electronic health records in the U.S.

•Institutional forces can explain the adoption of electronic health records (EHRs) in ambulatory medical practices in the U.S.•Prior to U.S. government incentives, mimetic forces had a slightly lesser effect on adoption than normative forces.•Coercive forces introduced with the U.S. government incentives/penalties rival normative forces.•Normative forces have continually influenced EHR adoption decisions.

This study uses institutional theory to explain adoption of electronic health records (EHRs) in ambulatory medical practices in the U.S. Health care is a highly institutionalized industry, subject to multiple regulatory forces, high levels of professionalism, and growing network externalities that can influence adoption decisions. We found that mimetic forces were more critical predictors when there was greater uncertainty, coercive forces were significant predictors after the U.S. government established incentives, and normative forces have continually influenced adoption. This study demonstrates the impact of the institutional effect of government policies and industry norms on adoption of critical technologies.