• Julia Adler-Milstein, Jordan Everson, and Shoou-Yih D Lee.
• School of Information, University of Michigan, Ann Arbor, Michigan, USA Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
• J Am Med Inform Assoc. 2014 Nov 1; 21 (6): 984-91.

ObjectiveTo examine whether there is a common sequence of adoption of electronic health record (EHR) functions among US hospitals, identify differences by hospital type, and assess the impact of meaningful use.Materials And MethodsUsing 2008 American Hospital Association (AHA) Information Technology (IT) Supplement data, we calculate adoption rates of individual EHR functions, along with Loevinger homogeneity (H) coefficients, to assess the sequence of EHR adoption across hospitals. We compare adoption rates and Loevinger H coefficients for hospitals of different types to assess variation in sequencing. We qualitatively assess whether stage 1 meaningful use functions are those adopted early in the sequence.ResultsThere is a common sequence of EHR adoption across hospitals, with moderate-to-strong homogeneity. Patient demographic and ancillary results functions are consistently adopted first, while physician notes, clinical reminders, and guidelines are adopted last. Small hospitals exhibited greater homogeneity than larger hospitals. Rural hospitals and non-teaching hospitals exhibited greater homogeneity than urban and teaching hospitals. EHR functions emphasized in stage 1 meaningful use are spread throughout the scale.DiscussionStronger homogeneity among small, rural, and non-teaching hospitals may be driven by greater reliance on vendors and less variation in the types of care they deliver. Stage 1 meaningful use is likely changing how hospitals sequence EHR adoption--in particular, by moving clinical guidelines and medication computerized provider order entry ahead in sequence.ConclusionsWhile there is a common sequence underlying adoption of EHR functions, the degree of adherence to the sequence varies by key hospital characteristics. Stage 1 meaningful use likely alters the sequence.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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