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          Use of Electronic Health Records in U.S. Hospitals
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          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.
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