EMRs and clinical IS implementation in hospitals: a statewide survey.

PURPOSE Present an overview of clinical information systems (IS) in hospitals and analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics. METHODS We developed a survey instrument measuring clinical IS implementation and classified clinical IS across 5 EMR levels. The survey was administered to hospitals in a state with a large number of rural hospitals (84% response rate). FINDINGS Clinical IS were classified across 5 EMR levels, a useful approach for understanding the gaps in clinical IS in hospitals. Almost half (43%) of hospitals in Iowa were at EMR Level 0, with at least 1 of the ancillary systems still absent; 12% were at Level 1 with all 3 ancillary systems in place; 16% were at Level 2 corresponding to an early EMR system; 18% were at Level 3 corresponding to an intermediate EMR system; and 10% were at Level 4 corresponding to an advanced EMR system. In contrast, 22% had no plans for EMR implementation at all. EMR level was lower in critical access hospitals and positively associated with more slack resources and staffed beds. Over a 3-year period, there were increases in ancillary systems and clinical documentation implementation. CONCLUSIONS The survey performed well. There was agreement with published estimates of EMR penetration, sensitivity to change over time, and association with known organizational factors. It is well designed and can be used to map onto a comprehensive classification scheme capturing the EMR level and evaluating progress toward meaningful use.

[1]  Yan Hongqiao,et al.  Electronic Medical Records vs. Electronic Health Records:Yes,There Is a Difference , 2007 .

[2]  Sara Rosenbaum,et al.  How common are electronic health records in the United States? A summary of the evidence. , 2006, Health affairs.

[3]  C Sicotte,et al.  Exploring Health Information Technology Innovativeness and its Antecedents in Canadian Hospitals , 2009, Methods of Information in Medicine.

[4]  M. Jaana,et al.  Information technology capacities assessment tool in hospitals: Instrument development and validation , 2009, International Journal of Technology Assessment in Health Care.

[5]  Shannon H Houser,et al.  Perceptions regarding electronic health record implementation among health information management professionals in Alabama: a statewide survey and analysis. , 2008, Perspectives in health information management.

[6]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[7]  Guy Paré,et al.  Antecedents of Clinical Information Technology Sophistication in Hospitals , 2006, Health care management review.

[8]  Guy Paré,et al.  Information technology sophistication in health care: an instrument validation study among Canadian hospitals , 2001, Int. J. Medical Informatics.

[9]  Pengxiang Li,et al.  HIT Implementation in Critical Access Hospitals: Extent of Implementation and Business Strategies Supporting IT Use , 2011, Journal of Medical Systems.

[10]  Mirou Jaana,et al.  Clinical Information System Availability and Use in Urban and Rural Hospitals , 2006, Journal of Medical Systems.

[11]  David W. Bates,et al.  The use of health information technology in seven nations , 2008, Int. J. Medical Informatics.

[12]  C. DesRoches,et al.  A progress report on electronic health records in U.S. hospitals. , 2010, Health affairs.

[13]  J. Bahensky,et al.  Health care information technology in rural America: electronic medical record adoption status in meeting the national agenda. , 2008, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[14]  Guy Paré,et al.  Clinical information technology in hospitals: A comparison between the state of Iowa and two provinces in Canada , 2005, Int. J. Medical Informatics.