EHR adoption across China's tertiary hospitals: a cross-sectional observational study

Abstract

Heading: EHR adoption across China's tertiary hospitals: a cross-sectional observation study

Objectives: 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.

Keywords: Electronic health record; Evaluation; Health information systems; Technology assessment.