Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Special Article Use of Electronic Health Records in U.S. Hospitals Ashish K.

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Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D., and David Blumenthal, M.D., M.P.P. N Engl J Med 2009; 360:1628-1638 DOI: 10.1056/NEJMsa0900592.

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. Figure 1 Major Perceived Barriers to Adoption of Electronic Health Records (EHRs) among Hospitals with Electronic-Records Systems as Compared with Hospitals without Systems.

Hospitals with electronic-records systems include hospitals with a comprehensive electronic-records system and those with a basic electronic-records system that includes functionalities for physicians' notes and nursing assessments. Health care system faces challenges on multiple fronts, including rising costs and inconsistent quality. Health information technology, especially electronic health records, has the potential to improve the efficiency and effectiveness of health care providers.