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The purpose of this paper is to assess the appropriateness of equal weights estimation (sumscores) and the application of the composite equivalence index (CEI) vis-à-vis differentiated indicator weights produced by partial least squares structural equation modeling (PLS-SEM).

The authors rely on prior literature as well as empirical illustrations and a simulation study to assess the efficacy of equal weights estimation and the CEI.

The results show that the CEI lacks discriminatory power, and its use can lead to major differences in structural model estimates, conceals measurement model issues and almost always leads to inferior out-of-sample predictive accuracy compared to differentiated weights produced by PLS-SEM.

In light of its manifold conceptual and empirical limitations, the authors advise against the use of the CEI. Its adoption and the routine use of equal weights estimation could adversely affect the validity of measurement and structural model results and understate structural model predictive accuracy. Although this study shows that the CEI is an unsuitable metric to decide between equal weights and differentiated weights, it does not propose another means for such a comparison.

The results suggest that researchers and practitioners should prefer differentiated indicator weights such as those produced by PLS-SEM over equal weights.

To the best of the authors’ knowledge, this study is the first to provide a comprehensive assessment of the CEI’s usefulness. The results provide guidance for researchers considering using equal indicator weights instead of PLS-SEM-based weighted indicators.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.