Three of Four Hospitals have a Basic EHR System

In 2014, three out of four (76 percent) hospitals had adopted at least a basic EHR system, according to a brief issued by the Office of the National Coordinator for Health Information Technology (ONC). According to the feds, this number represents an increase of 27 percent from 2013 and an eight-fold increase since 2008.

Nearly all reported hospitals (97 percent) possessed a certified EHR technology in 2014, increasing by 35 percent since 2011. State rates of hospital adoption of at least a basic EHR system ranged from 50 percent to 100 percent. Delaware (100 percent), South Dakota (95 percent) and Virginia (93 percent) had the highest percent of hospitals with adoption of at least a basic EHR system. West Virginia (50 percent), Hawaii (55 percent) and Kansas (60 percent) had the lowest percent of hospitals with adoption of at least a basic EHR system.

According to the ONC, in 2008 hospital adoption of at least a basic EHR system was above 20 percent in only two states (Connecticut and New Mexico). Three years later, hospital adoption of at least a basic EHR system was above 20 percent in 32 states and above 40 percent in seven states. In 2014, hospital adoption of at least a basic EHR system was above 60 percent in all but two states (Hawaii and West Virginia), and above 80 percent in 17 states.

Hospital adoption of comprehensive EHR systems has increased eleven-fold since 2009, rising to a third (34.4 percent) of hospitals in 2014.

Thus, says the ONC, adoption of EHR systems by non-federal acute care hospitals has steadily increased since HITECH. Basic EHR adoption represents a minimum use of core functionality determined to be essential to an EHR system. In 2014, three of four (76 percent) non-federal acute care hospitals had adopted at least a basic EHR system with clinician notes. This represents a 27 percent increase from the previous year and a more than eight-fold increase in EHR adoption since 2008.

At 16 percentage points higher than 2013, this is the second highest increase in adoption since 2012 (17 percentage points). Moreover, since the passage of the HITECH Act in 2009, state EHR adoption rates have increased. EHR adoption rates increased from only two states reporting rates higher than 20 percent to all states reporting rates 50 percent or higher by 2014. Furthermore, only two states currently have adoption rates below 60 percent.

In addition to growth in EHR adoption overall, hospital adoption of technology with advanced functionality increased significantly. While fewer hospitals used basic EHR systems without clinician notes, significantly more adopted systems with clinician notes. Additionally, more than a third of hospitals were using more advanced EHR functionality. Hospital adoption of comprehensive EHR systems has increased more than eleven-fold in the last five years.

Finally, a vast majority of acute care hospitals (97 percent) possessed EHR technology certified to meet federal requirements. These hospitals should have the technology needed to meet EHR Incentive Program objectives. These systems are also certified to be secure and able to work with other certified systems to share information. Thus, the increase in the rate of adoption for certified EHR technology shed a positive light on hospitals’ progress towards the interoperable exchange of health information.

Data collected and reported on by the ONC was collected by the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey. Since 2008, the ONC partnered with the AHA to measure the adoption and use of health IT in U.S. hospitals. The ONC funded the 2014 AHA IT Supplement Survey to track hospital adoption and use of EHRs and the exchange of clinical data. The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital’s health IT (typically the chief information officer) was requested to provide the information via a mail survey or secure online site. Non-respondents received follow-up mailings and phone calls to encourage a response. The survey was fielded from November 2014 to the end of February 2015.

This analysis consisted of non-federal acute care hospitals, including children’s and cancer hospitals.  Differences in the estimates in this brief from a prior study reporting Basic EHR adoption with clinician notes are because of the inclusion of children’s and cancer hospitals and small differences in the calculation of hospital-level weights.

The response rate for non-federal acute care hospitals was 60 percent. A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, ownership, teaching status, system membership, availability of a cardiac intensive care unit, urban status and region. Hospital-level weights were derived by the inverse of the predicted propensity.

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