title: EHR adoption across China's tertiary hospitals: a cross-sectional observational study.
abstract: EHR adoption across China's tertiary hospitals: a cross-sectional observation study
  
  
  OBJECTIVE
  To assess electronic health record (EHR) adoption in Chinese tertiary hospitals using a nation-wide standard EHR grading model.
  
  
  METHODS
  The Model of EHR Grading (MEG) was used to assess the level of EHR adoption across 848 tertiary hospitals. MEG defines 37 EHR functions (e.g., order entry) which are grouped by 9 roles (e.g., inpatient physicians) and grades each function and the overall EHR adoption into eight levels (0-7). We assessed the MEG level of the involved hospitals and calculated the average score of the 37 EHR functions. A multivariate analysis was performed to explore the influencing factors (including hospital characteristics and information technology (IT) investment) of total score and scores of 9 roles.
  
  
  RESULTS
  Of the 848 hospitals, 260 (30.7%) were Level Zero, 102 (12.0%) were Level One, 269 (31.7%) were Level Two, 188 (22.2%) were Level Three, 23 (2.7%) were Level Four, 5 (0.6%) was Level Five, 1 (0.1%) were Level Six, and none achieved Level Seven. The scores of hospitals in eastern and western China were higher than those of hospitals in central areas. Bed size, outpatient admission, total income in 2011, percent of IT investment per income in 2011, IT investment in last 3 years, number of IT staff, and duration of EHR use were significant factors for total score.
  
  
  CONCLUSIONS
  We examined levels of EHR adoption in 848 Chinese hospitals and found that most of them have only basic systems, around level 2 and 0. Very few have a higher score and level for clinical information using and sharing.
authors.affiliation: National Institute of Hospital Administration, Ministry of Health, China. Electronic address: nctingting@126.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Shu
authors.affiliation: Qinghua Changgeng Hospital, China.
authors.forename: Haiyi
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Tufts Medical Center, Boston, United States.
authors.forename: Foster R
authors.initials: FR
authors.lastname: Goss
authors.affiliation: National Institute of Hospital Administration, Ministry of Health, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, United States; Clinical Informatics Research & Development, Partners HealthCare System, Inc., United States.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, United States; Clinical and Quality Analysis, Partners HealthCare System, Inc., United States.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.affiliation: National Institute of Hospital Administration, Ministry of Health, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Liang
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D062606:Tertiary Care Centers / Q000458:organization & administration*
keywords: Electronic health record; Evaluation; Health information systems; Technology assessment