Electronic health record adoption by children's hospitals in the United States.

OBJECTIVE

To assess adoption of electronic health records (EHRs) and clinical functionalities, involvement in health information exchange, and barriers to and facilitators of adoption among children's hospitals in the United States.

DESIGN

Survey presented as an information technology supplement to the American Hospital Association's annual member survey.

SETTING

General acute care children's hospitals in 2008, identified using the membership directory of the National Association of Children's Hospitals and Related Institutions.

PARTICIPANTS

Chief information officers or equivalent hospital leaders.

MAIN EXPOSURES

Potential barriers to or facilitators of EHR adoption.

MAIN OUTCOME MEASURES

Rates of EHR adoption, determined using expert-formulated definitions based on presence of essential functionalities, and rates of implementation for individual functionalities and participation in health information exchange.

RESULTS

Of 155 children's hospitals, 108 (69.7%) responded to the survey. Only 2.8% had a comprehensive EHR, whereas an additional 17.9% had a basic system. Adoption of individual functionalities varied widely; comprehensive implementations of computerized provider order entry for medications and many forms of decision support were reported by fewer than half. In all, 15.7% of hospitals exchanged health information electronically. Hospital characteristics were not associated with EHR adoption or participation in health information exchange. Hospitals identified financing as the most important target for policy strategies.

CONCLUSIONS

Most children's hospitals lack the minimum functionalities needed for a basic EHR. Ensuring access to adequate financial resources will be critical for inclusion of children's hospitals in efforts to expand EHR use.