BACKGROUND: Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. PURPOSES: Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. METHODOLOGY/APPROACH: A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. FINDINGS: Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B =-5.64, p =.10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p <.001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p =.049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p =.042). PRACTICE IMPLICATIONS: By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.