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Comparing the Trends of Electronic Health Record Adoption Among Hospitals of the United States and Japan

  • Systems-Level Quality Improvement
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Abstract

The goal of this study is to examine the trends of Electronic Health Record (EHR) adoption among hospitals in Japan compared to those in the United States. Japan’s nationwide survey of hospitals was utilized to extract the EHR adoption rates among Japanese hospitals. Comparable datasets from the Healthcare Information and Management System Society (HIMSS) and the American Hospital Association (AHA) were utilized to extract EHR adoption rates among U.S. hospitals. The trends of EHR adoption were stratified and analyzed by hospital size and hospital ownership status. As of 2014, the U.S. hospitals had a wider adoption of ‘basic with clinical notes’ EHRs compared to Japan (45.6% vs. 27.3%), but large hospitals (400+ beds) in Japan have shown a similar adoption rate of EHR systems than those of U.S. (65.6% vs. 68.5%). Governmental hospitals tend to be more advanced in EHR adoption than non-profit hospitals in Japan (53.0% vs. 21.5%). Non-profit hospitals show the highest adoption rate of ‘basic’ EHR systems in the U.S. as of 2014 (63.3%). Using the ‘certified’ definition of EHRs, the EHR adoption rate was close to 96% among U.S. hospitals as of 2016; however, updated EHR adoption data from Japanese hospitals has yet to be collected and published. U.S. and Japan have considerably increased EHR adoption among hospitals; however, this analysis indicates different trends of EHR adoption among hospitals by size and ownership status in both countries. Learnings from government programs supporting EHR adoption in the U.S. and Japan can be helpful in planning useful strategies for future hospital-oriented health IT policies in other developed nations.

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Acknowledgements

We thank Dr. Okada Chiharu, MD PhD, from the National Hospital Organization (Tokyo, Japan), for his support and feedback about the MHLW data as well as the overall interpretation of our results within the Japanese healthcare context. We also acknowledge Dr. Eric Ford at the Johns Hopkins School of Public Health (Baltimore, U.S.) for his insightful input and HIMSS (Chicago, U.S.) for providing us with the EMRAM datasets.

Availability of Data

MHLW data are publicly available [13, 14]. EMRAM data are proprietary and can be acquired for a fee from HIMSS [35].

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Authors and Affiliations

  1. Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA

    Takako Kanakubo & Hadi Kharrazi

  2. Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA

    Hadi Kharrazi

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  1. Takako Kanakubo
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All authors were actively involved in the development of the study’s aim. All authors reviewed, commented, and revised the manuscript as needed. HK and TK led the study. HK and TK co-led the analysis and interpretation of the results, as well as drafting the manuscript. HK prepared the manuscript for submission.

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Correspondence to Hadi Kharrazi.

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Appendices

Appendix A

Table 2 Terminology used to compare Japan and U.S. hospitals
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Table 3 Comparing ownership terminologies
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Table 4 Comparing teaching status terminologies
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Table 5 Comparing geographical category terminologies
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Appendix B

Table 6 EHR functions used to define ‘basic’, ‘basic with clinical notes’ and ‘comprehensive’ EHR systems
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Appendix C

Fig. 4
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EHR adoption rates among hospitals in Japan versus the United States*

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Kanakubo, T., Kharrazi, H. Comparing the Trends of Electronic Health Record Adoption Among Hospitals of the United States and Japan. J Med Syst 43, 224 (2019). https://doi.org/10.1007/s10916-019-1361-y

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