Background
Despite a consensus that the use of health information technology should lead to
more efficient, safer, and higher-quality care, there are no reliable estimates of the
prevalence of adoption of electronic health records in U.S. hospitals.
Methods
We surveyed all acute care hospitals that are members of the American Hospital
Association for the presence of specific electronic-record functionalities. Using a
definition of electronic health records based on expert consensus, we determined
the proportion of hospitals that had such systems in their clinical areas. We also
examined the relationship of adoption of electronic health records to specific hospital
characteristics and factors that were reported to be barriers to or facilitators
of adoption.
Results
On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals
have a comprehensive electronic-records system (i.e., present in all clinical
units), and an additional 7.6% have a basic system (i.e., present in at least one clinical
unit). Computerized provider-order entry for medications has been implemented in
only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching
hospitals were more likely to have electronic-records systems. Respondents cited capital
requirements and high maintenance costs as the primary barriers to implementation,
although hospitals with electronic-records systems were less likely to cite
these barriers than hospitals without such systems.
Conclusions
The very low levels of adoption of electronic health records in U.S. hospitals suggest
that policymakers face substantial obstacles to the achievement of health care performance
goals that depend on health information technology. A policy strategy focused
on financial support, interoperability, and training of technical support staff
may be necessary to spur adoption of electronic-records systems in U.S. hospitals. |
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