This policy document was prepared by Janet Rayner, Ruth Holt, Fiona Blinkhorn and Karen Duncan. Policy documents produced by BSPD represent a majority view, based on a consideration of currently available evidence. They are produced to provide guidance, with the clear intention that the policy be regularly reviewed and updated to take account of changing views and developments.

Background Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. Methods EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. Results We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. Conclusion Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.

Background Considering the benefits of using electronic health records (EHR) for maintaining the overall quality of clinical care, the nationwide adoption of EHR in hospitals has become a policy priority. The electronic medical record maturity model (EMRAM) is one of the most popular survey tools developed by the Healthcare Information and Management Systems Society (HIMSS) that measures the level of adoption for EHR functions in a hospital or a secondary care setting. This study aims to measure the digital capacity of public hospitals in Turkey and criticize the relation between adoption and hospital size. Methods EMRAM surveys were completed by 600 (68.9%) public hospitals of Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated.Results We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which is better than the results of Korean hospitals of 2017 but still lower than the USA hospitals of 2015 (1)[1]and 2017. Our findings suggest that small hospitals are better than larger hospitals at adopting certain EHR functions. Conclusion Measuring the overall adoption level of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all public hospitals in a country by using EMRAM. The results are used by MoH of Turkey to disseminate the benefits of EHR functions overall in the country.