Julia Adler-Milstein1, Jordan Everson2, Shoou-Yih D Lee2. 1. School of Information, University of Michigan, Ann Arbor, Michigan, USA Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. 2. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
OBJECTIVE: To examine whether there is a common sequence of adoption of electronic health record (EHR) functions among US hospitals, identify differences by hospital type, and assess the impact of meaningful use. MATERIALS AND METHODS: Using 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data, we calculate adoption rates of individual EHR functions, along with Loevinger homogeneity (H) coefficients, to assess the sequence of EHR adoption across hospitals. We compare adoption rates and Loevinger H coefficients for hospitals of different types to assess variation in sequencing. We qualitatively assess whether stage 1 meaningful use functions are those adopted early in the sequence. RESULTS: There is a common sequence of EHR adoption across hospitals, with moderate-to-strong homogeneity. Patient demographic and ancillary results functions are consistently adopted first, while physician notes, clinical reminders, and guidelines are adopted last. Small hospitals exhibited greater homogeneity than larger hospitals. Rural hospitals and non-teaching hospitals exhibited greater homogeneity than urban and teaching hospitals. EHR functions emphasized in stage 1 meaningful use are spread throughout the scale. DISCUSSION: Stronger homogeneity among small, rural, and non-teaching hospitals may be driven by greater reliance on vendors and less variation in the types of care they deliver. Stage 1 meaningful use is likely changing how hospitals sequence EHR adoption--in particular, by moving clinical guidelines and medication computerized provider order entry ahead in sequence. CONCLUSIONS: While there is a common sequence underlying adoption of EHR functions, the degree of adherence to the sequence varies by key hospital characteristics. Stage 1 meaningful use likely alters the sequence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To examine whether there is a common sequence of adoption of electronic health record (EHR) functions among US hospitals, identify differences by hospital type, and assess the impact of meaningful use. MATERIALS AND METHODS: Using 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data, we calculate adoption rates of individual EHR functions, along with Loevinger homogeneity (H) coefficients, to assess the sequence of EHR adoption across hospitals. We compare adoption rates and Loevinger H coefficients for hospitals of different types to assess variation in sequencing. We qualitatively assess whether stage 1 meaningful use functions are those adopted early in the sequence. RESULTS: There is a common sequence of EHR adoption across hospitals, with moderate-to-strong homogeneity. Patient demographic and ancillary results functions are consistently adopted first, while physician notes, clinical reminders, and guidelines are adopted last. Small hospitals exhibited greater homogeneity than larger hospitals. Rural hospitals and non-teaching hospitals exhibited greater homogeneity than urban and teaching hospitals. EHR functions emphasized in stage 1 meaningful use are spread throughout the scale. DISCUSSION: Stronger homogeneity among small, rural, and non-teaching hospitals may be driven by greater reliance on vendors and less variation in the types of care they deliver. Stage 1 meaningful use is likely changing how hospitals sequence EHR adoption--in particular, by moving clinical guidelines and medication computerized provider order entry ahead in sequence. CONCLUSIONS: While there is a common sequence underlying adoption of EHR functions, the degree of adherence to the sequence varies by key hospital characteristics. Stage 1 meaningful use likely alters the sequence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Adoption; Electronic Health Records; Hospitals; Meaningful Use
Authors: Amit X Garg; Neill K J Adhikari; Heather McDonald; M Patricia Rosas-Arellano; P J Devereaux; Joseph Beyene; Justina Sam; R Brian Haynes Journal: JAMA Date: 2005-03-09 Impact factor: 56.272
Authors: Basit Chaudhry; Jerome Wang; Shinyi Wu; Margaret Maglione; Walter Mojica; Elizabeth Roth; Sally C Morton; Paul G Shekelle Journal: Ann Intern Med Date: 2006-04-11 Impact factor: 25.391
Authors: Ashish K Jha; Catherine M DesRoches; Eric G Campbell; Karen Donelan; Sowmya R Rao; Timothy G Ferris; Alexandra Shields; Sara Rosenbaum; David Blumenthal Journal: N Engl J Med Date: 2009-03-25 Impact factor: 91.245
Authors: Catherine M DesRoches; Dustin Charles; Michael F Furukawa; Maulik S Joshi; Peter Kralovec; Farzad Mostashari; Chantal Worzala; Ashish K Jha Journal: Health Aff (Millwood) Date: 2013-07-09 Impact factor: 6.301
Authors: John A Batsis; Peter R DiMilia; Lillian M Seo; Karen L Fortuna; Meaghan A Kennedy; Heather B Blunt; Pamela J Bagley; Jessica Brooks; Emma Brooks; Soo Yeon Kim; Rebecca K Masutani; Martha L Bruce; Stephen J Bartels Journal: J Am Geriatr Soc Date: 2019-05-08 Impact factor: 5.562
Authors: Matthew D Krasowski; Caleb V Grieme; Brian Cassady; Nicholas R Dreyer; Karolyn A Wanat; Maia Hightower; Kenneth G Nepple Journal: J Pathol Inform Date: 2017-11-23
Authors: Nicholas L Kolodychuk; Michael Wong; George Chimento; Tyler Adams; Mariella Gastanaduy; Bradford S Waddell Journal: Arthroplast Today Date: 2019-02-22