The Use of Electronic Health Records in U.S. Hospitals

Electronic health-records (EHR) systems hold great promise to improve health care efficiency and quality while lowering costs. However, little research on how many U.S. hospitals have actually adopted EHRs has been done. This study examined all acute care hospitals that are members of the American Hospital Association to determine how many of them used EHRs, and examined specific characteristics of hospitals to help identify barriers and facilitators to EHR adoption; after exclusions, a total of 2,952 hospitals were analyzed. The authors hypothesized that larger hospitals and teaching hospitals would have higher prevalence of EHRs.

Results showed that a very low number of hospitals had adopted EHRs, according to the criteria used in this study to define an EHR. Only 1.6 percent of U.S. hospitals had a comprehensive EHR, and an additional 8.0 percent had a basic EHR (e.g., one that included physician and nursing notes available in at least one clinical unit). The hypothesis concerning larger hospitals and teaching hospitals was upheld, but differences were small. Hospitals that did not have EHRs cited financial considerations as major barriers, as well as physician resistance, unclear return on investment, and lack of staff with adequate IT expertise. However, many of the hospitals used some aspects of an EHR, such as electronic laboratory and radiologic reports, images and medication lists. These data suggest that fruitful policies should include rewarding hospitals for using technology to speed the adoption of EHRs; these policies could include providing incentives for hiring more IT staff, harmonizing standards, and others.

Limitations of this study include that nonresponding hospitals were somewhat different than responding hospitals, possibly leading to an overestimation of the number of hospitals that have actually adopted EHRs. Also, the study focused on adoption, rather than use of EHRs and/or satisfaction with them. Nevertheless, results point to the fact that an extremely small percentage of U.S. hospitals even have comprehensive EHRs in place. Policy-makers hoping to promote EHR adoption should focus on offering financial, technical and training support to hospitals and staff.