title: Rates, levels, and determinants of electronic health record system adoption: a study of hospitals in Riyadh, Saudi Arabia.
abstract: OBJECTIVE
  Outside a small number of OECD countries, little information exists regarding the rates, levels, and determinants of hospital electronic health record (EHR) system adoption. This study examines EHR system adoption in Riyadh, Saudi Arabia.
  
  
  METHODS
  Respondents from 22 hospitals were surveyed regarding the implementation, maintenance, and improvement phases of EHR system adoption. Thirty-seven items were graded on a three-point scale of preparedness/completion. Measured determinants included hospital size, level of care, ownership, and EHR system development team composition.
  
  
  RESULTS
  Eleven of the hospitals had implemented fully functioning EHR systems, eight had systems in progress, and three had not adopted a system. Sixteen different systems were being used across the 19 adopting hospitals. Differential adoption levels were positively related to hospital size and negatively to the level of care (secondary versus tertiary). Hospital ownership (nonprofit versus private) and development team composition showed mixed effects depending on the particular adoption phase being considered.
  
  
  CONCLUSIONS
  Adoption rates compare favourably with those reported from other countries and other districts in Saudi Arabia, but wide variations exist among hospitals in the levels of adoption of individual items. General weaknesses in the implementation phase concern the legacy of paper data systems, including document scanning and data conversion; in the maintenance phase concern updating/maintaining software; and in the improvement phase concern the communication and exchange of health information.
  
  
  CONCLUSIONS
  This study is the first to investigate the level and determinants of EHR system adoption for public, other nonprofit, and private hospitals in Saudi Arabia. Wide interhospital variations in adoption bear implications for policy-making and funding intervention. Identified areas of weakness require action to increase the degree of adoption and usefulness of EHR systems.
authors.affiliation: Department of Health Informatics, King Saud Bin AbdulAziz University, Mail Code: 2350, PO Box 22490, Riyadh 11426, Saudi Arabia. Electronic address: dosarib@hotmail.com.
authors.forename: Bakheet
authors.initials: B
authors.lastname: Aldosari
mesh_terms: D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000458:organization & administration / Q000706:statistics & numerical data*; D063025:Health Information Management / Q000458:organization & administration / Q000706:statistics & numerical data*; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006739:Hospital Administration; D006801:Humans; D010067:Ownership; D011216:Practice Management, Medical / Q000458:organization & administration*; D012529:Saudi Arabia
keywords: Electronic health records; Hospital information systems; Levels and determinants of EHR system adoption; Saudi Arabia