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Previous Volume 360:1628-1638 April 16, 2009 Number 16 Next

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ABSTRACT

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.

Source Information

From the Department of Health Policy and Management, Harvard School of Public Health (A.K.J.); the Division of General Medicine, Brigham and Women's Hospital (A.K.J.); the Veterans Affairs Boston Healthcare System (A.K.J.); and the Institute for Health Policy (C.M.D., E.G.C., K.D., S.R.R., T.G.F., A.S., D.B.) and the Biostatistics Center (S.R.R.), Massachusetts General Hospital — all in Boston; and the Department of Health Policy, George Washington University, Washington, DC (S.R.).

This article (10.1056/NEJMsa0900592) was published at NEJM.org on March 25, 2009.

Address reprint requests to Dr. Jha at the Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, or at ajha{at}hsph.harvard.edu.

Full Text of this Article

Related Letters:

Electronic Health Records in Hospitals
Lipschutz J. H., Mueller J. T., Trentman T. L., Miziara I. D., Jha A. K., DesRoches C., Rosenbaum S.
Extract | Full Text | PDF  
N Engl J Med 2009; 361:421-422, Jul 23, 2009. Correspondence

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