Which Hospitals Are More Likely to Adopt EHR? Findings from a Recent National Survey

Background: Health information technology is a rapidly growing, but only a small percentage of healthcare facilities have fully adopted an electronic health record system (EHR).

Objective: To explore factors associated with the level of hospital adoption of EHR systems.

Methods: Data were abstracted from the 2007 American Hospital Association's Hospital EHR Adoption Survey of 3,451 hospitals. Hospitals were grouped based on their level of adoption of an EHR system; all electronic, partially electronic, or not electronic at all. Factors associated with the level of adoption included organizational factors, managed care influence, market competition, and geographic factors.

Results: Hospitals with full EHR were more likely to be in a centralized physician/insurance health system (OR [CI)], 2.64 [1.55, 4.49]); less likely to be in a network ((OR) [CI], 0.70 [0.50, 0.99]); and less likely to be located in the mid-Atlantic Census division ((OR) [CI], 0.47 [0.24, 0.92]). Every 100-bed increase resulted in a 19% increase in the odds of EHR adoption. Hospitals that were not electronic at all were more likely to be public ((OR) [CI], 1.62 [1.28, 2.05]) and investor-owned ((OR) [CI], 3.07 [2.33, 4.06]); more likely to be in an independent hospital system ((OR) [CI], 1.92 [1.34, 2.76]); less likely to be located in the New England ((OR) [CI], 0.47 [0.27, 0.81]) and the East North Central divisions ((OR) [CI], 0.74 [0.56, 0.98]), but more likely to be located in West North Central division ((OR) [CI], 1.38 [1.05, 1.79]). Significantly more hospitals without EHR systems ranked lack of capital, cost of maintaining electronic systems, and lack of IT resources as major barriers to adopting EHR.

Conclusion: Hospital size, ownership, type of system and network affiliation, and geographic location are associated with the level of EHR adoption. Financial considerations and lack of IT resources are major barriers to hospitals adopting EHR.