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.


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


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


METHODS
Chief information officers or equivalent hospital leaders.


METHODS
Potential barriers to or facilitators of EHR adoption.


METHODS
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.
Division of Infectious Diseases, Department of Medicine, Children’s Hospital Boston, Boston, Massachusetts 02115, USA.
Mari M
MM
Nakamura
Timothy G
TG
Ferris
Catherine M
CM
DesRoches
Ashish K
AK
Jha
D001291:Attitude of Health Personnel; D002648:Child; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006776:Hospitals, Pediatric; D006801:Humans; D033183:Interdisciplinary Communication; D010818:Practice Patterns, Physicians'; D014481:United States