The Adoption Level of Electronic Health Records in Turkish Hospitals and the Relation with Hospital Sizes

Abstract

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. Turkey has accomplished many standardizations and infrastructural studies in the health IT domain as a part of the first phase of the Health Transformation Program between 2003 and 2017. The Turkish MoH applied a bottom-up approach to adopting EHR in public hospitals, as the USA did. This study aims to measure the EHR adoption level 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 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. It can be suggested that using a bottom-up approach as applied by the USA on adopting EHR in public hospital gives successful results also in Turkey. The results are used by MoH of Turkey to disseminate the benefits of EHR functions overall in the country.