Alternative Measures of Electronic Health Record Adoption Among Hospitals

Objective: To develop measures of the use of electronic health records (EHRs) that accurately reflect the full continuum of hospital adoption and progress toward meaningful use and to understand the intercorrelations and patterns associated with hospital adoption of specific EHR functions. Study Design: This study analyzed the 2009 American Hospital Association (AHA) information technology (IT) supplement survey. The main section of this survey assessed the adoption and use of 24 EHR functionalities in the following major categories: electronic clinical documentation, results viewing, computerized provider order entry, and clinical decision support. Methods: This study relied on descriptive statistical methods and a principal component factor analysis. Results: We found that 11.4% of hospitals met all and 48.3% met half or more of the core criteria that are included in both the AHA IT survey and the final "meaningful-use" rule. The results from our factor analysis imply that hospitals adopt groups of similar EHR functions, but choices to adopt across major categories are relatively independent. Conclusions: Many hospitals have adopted multiple features of EHRs and tend to use a staged adoption strategy based on logical groupings of functions. These results indicate to policymakers that there is no single path toward adoption of advanced EHR systems. (Am J Manag Care. 2010; 16(12 Spec No.): e293-e301)