EMRs and clinical IS implementation in hospitals: a statewide survey

Present an overview of clinical information systems (IS) in hospitals and analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics.

We developed a survey instrument measuring clinical IS implementation and classified clinical IS across 5 EMR levels. The survey was administered to hospitals in a state with a large number of rural hospitals (84% response rate).

Clinical IS were classified across 5 EMR levels, a useful approach for understanding the gaps in clinical IS in hospitals. Almost half (43%) of hospitals in Iowa were at EMR Level 0, with at least 1 of the ancillary systems still absent; 12% were at Level 1 with all 3 ancillary systems in place; 16% were at Level 2 corresponding to an early EMR system; 18% were at Level 3 corresponding to an intermediate EMR system; and 10% were at Level 4 corresponding to an advanced EMR system. In contrast, 22% had no plans for EMR implementation at all. EMR level was lower in critical access hospitals and positively associated with more slack resources and staffed beds. Over a 3-year period, there were increases in ancillary systems and clinical documentation implementation.

The survey performed well. There was agreement with published estimates of EMR penetration, sensitivity to change over time, and association with known organizational factors. It is well designed and can be used to map onto a comprehensive classification scheme capturing the EMR level and evaluating progress toward meaningful use.