NCHS Data Brief ■ No. 187 ■ February 2015

u.s. department of health and human services

centers for disease control and prevention

national center for health statistics

Progress With Electronic Health Record Adoption Among 

Emergency and Outpatient Departments:

United States, 2006–2011

Eric Jamoom, Ph.D., M.P.H., M.S.; and Esther Hing, M.P.H.

Key findings 

Data from the 2006–

2011 National Hospital 

Ambulatory Medical Care 

Survey

● In 2011, 84% of hospital 

emergency departments (EDs) 

used an electronic health record 

(EHR) system.

● Adoption of a basic EHR 

system with a specific set 

of functionalities by EDs 

increased from 19% in 2007 to 

54% in 2011.

● In 2011, 73% of hospital 

outpatient departments (OPDs) 

used an EHR system, up from 

29% in 2006.

● Adoption of a basic EHR 

system with a specific set 

of functionalities by OPDs 

increased from 9% in 2007 to 

57% in 2011.

● From 2007 through 2011, 

adoption of Stage 1 Meaningful 

Use objectives by EDs and 

OPDs increased.

● In 2011, 14% of EDs 

and 16% of OPDs had EHR 

technology able to support 

nine Stage 1 Meaningful Use 

objectives.

The Health Information Technology for Economic and Clinical Health 

(HITECH) Act of 2009 provides incentive payments to eligible hospitals and 

providers that demonstrate the meaningful use of a certified electronic health 

record (EHR) system (1,2). This report describes the adoption of EHRs in 

hospital emergency departments (EDs) and outpatient departments (OPDs) 

from 2006 through 2011 using the National Hospital Ambulatory Medical 

Care Survey (NHAMCS). 

Keywords: health information technology • National Hospital Ambulatory 

Medical Care Survey

Use of an EHR system in EDs increased from 2006 through 

2011. 

● In 2011, 84% of EDs reported using an EHR system, up from 46% in 

2006 (Figure 1).

Figure 1. Hospital emergency departments with an EHR system: United States, 2006–2011

NOTES: All trends were significant (p < 0.05). EHR is electronic health record. “Any EHR system” is a medical or health record 

system that is either all or partially electronic. Emergency department estimates are based on a question indicating the 

department “uses” an EHR. Estimates for a basic system prior to 2007 were not included, as not all data elements were collected. 

A basic system had all of the following functionalities: patient history and demographics, patient problem lists, physician clinical 

notes, comprehensive list of patients’ medications and allergies, computerized orders for prescriptions, and ability to view 

laboratory and imaging results electronically.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2006–2011. Percent

0

20

40

60

80

100

2006 2007 2008 2009 2010 2011

46.2

61.6

71.7 73.8 70.8

83.7

18.5

23.8

30.2

45.0

53.6

Any EHR system

Basic system
NCHS Data Brief ■ No. 187 ■ February 2015

■  2  ■

● Adoption of a basic EHR system by hospital EDs increased from 19% in 2007 to 54% in 

2011.

Use of an EHR system in OPDs increased from 2006 through 2011. 

● OPD use of an EHR system increased from 29% in 2006 to 73% in 2011 (Figure 2).

● OPD adoption of a basic EHR system increased from 9% in 2007 to 57% in 2011. Percent

Figure 2. Hospital outpatient departments with an EHR system: United States, 2006–2011

NOTES: All trends were significant (p < 0.05). EHR is electronic health record. “Any EHR system” is a medical or health record system that is either all or partially 

electronic. Outpatient department estimates are based on a question indicating the department “uses” an EHR. Estimates for a basic system prior to 2007 are not 

included, as not all data elements were collected. A basic system had all of the following functionalities: patient history and demographics, patient problem lists, 

physician clinical notes, comprehensive list of patients’ medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging 

results electronically.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2006–2011.

29.4

49.8

57.2

63.6

67.5

73.3

8.9

19.0 18.1

34.9

57.4

0

20

40

60

80

2006 2007 2008 2009 2010 2011

Any EHR system

Basic system
NCHS Data Brief ■ No. 187 ■ February 2015

■  3  ■

From 2007 through 2011, the percentage of EDs with EHR technology that 

supported Stage 1 Meaningful Use objectives increased. 

● Information on 5 of 14 Stage 1 Meaningful Use objectives was collected in NHAMCS from 

2007 through 2011. 

● Over the 5-year period, EDs with an EHR system able to support Stage 1 objectives 

increased for the following four objectives: providing warnings of drug interactions or 

contraindications (from 28% to 43%), providing reminders for guideline-based interventions 

(from 28% to 40%), ordering prescriptions (from 39% to 63%), and recording patient 

problem list (from 45% to 65%) (Figure 3).

● In 2011, EDs with an EHR system able to support Stage 1 Meaningful Use objectives 

ranged from 40% (providing reminders for guideline-based interventions) to 87% (recording 

patient demographics).

Percent

Figure 3. Hospital emergency departments with EHR technology able to support selected Stage 1 Meaningful Use 

objectives: United States, 2007–2011

NOTES: All trends were significant (p < 0.05) except for recording patient demographics. EHR is electronic health record. Information on 5 of 14 Stage 1 

Meaningful Use objectives was collected in the National Hospital Ambulatory Medical Care Survey from 2007 through 2011. See reference 4 for Stage 1 

Meaningful Use objectives.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2007–2011.

82.4

92.4 89.4 88.3 87.0

44.6

42.4

48.9

65.1

38.6

47.0

55.2

61.6

61.1 62.6

28.0

33.9

40.3

44.3 42.9

28.4

31.5 29.0

33.0

39.9

0

20

40

60

80

100

2007 2008 2009 2010 2011

Recording patient history and

demographic information

Recording patient problem list

Ordering prescriptions

Providing warnings of drug

interactions or contraindications

Providing reminders for

guideline-based interventions
NCHS Data Brief ■ No. 187 ■ February 2015

■  4  ■

From 2007 through 2011, hospital OPDs with EHR technology that 

supported Stage 1 Meaningful Use objectives increased. 

● Information on 5 of 14 Stage 1 Meaningful Use objectives was collected in NHAMCS from 

2007 through 2011.

● Over the 5-year period, OPDs with an EHR system able to support Stage 1 objectives 

increased for the following four objectives: recording patient problem lists (from 28% to 

70%), ordering prescriptions (from 27% to 60%), providing warnings or contraindications 

(from 21% to 48%), and providing guideline-based interventions (from 21% to 46%) 

(Figure 4). 

● In 2011, OPDs with an EHR system able to support Stage 1 Meaningful Use objectives 

ranged from 46% (providing reminders for guideline-based interventions) to 84% (recording 

patient demographics).

Percent

Figure 4. Hospital outpatient departments with EHR technology able to support selected Stage 1 Meaningful Use 

objectives: United States, 2007–2011

NOTES: All trends were significant (p < 0.05) except for recording patient demographics. EHR is electronic health record. Information on 5 of 14 Stage 1 

Meaningful Use objectives was collected in the National Hospital Ambulatory Medical Care Survey from 2007 through 2011. See reference 4 for Stage 1 

Meaningful Use objectives.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2007–2011.

0

20

40

60

80

100

2007 2008 2009 2010 2011

Recording patient history and

demographic information

Recording patient problem list

Ordering prescriptions

Providing warnings of drug

interactions or contraindications

Providing reminders for

guideline-based interventions

76.0

83.4

77.4

86.5 83.9

39.2 39.5

61.9

70.4

27.6 34.0

31.8

55.1

60.3

47.5

26.8

20.6

26.1 28.4

41.3

20.5

25.5 27.4

37.2

45.7
NCHS Data Brief ■ No. 187 ■ February 2015

■  5  ■

In 2011, a limited number of EDs and OPDs had an EHR system that 

supported nine Stage 1 Meaningful Use objectives. 

● In 2011, information on 9 of 14 Stage 1 Meaningful Use objectives was collected in 

NHAMCS. 

● In 2011, 14% of EDs had EHR technology able to support 9 of 14 Stage 1 Meaningful Use 

objectives, while 16% of OPDs had such EHR technology (Figure 5).

Percent of hospital departments

Figure 5. Hospital outpatient and emergency departments with EHR technology able to support nine Stage 1 Meaningful 

Use objectives: United States, 2011

NOTES: Data include nonfederal hospitals. In 2011, information on nine Stage 1 Meaningful Use objectives was collected in the National Hospital Ambulatory 

Medical Care Survey. See reference 4 for Stage 1 Meaningful Use objectives. EHR is electronic health record.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2011.

14.4

16.4

0

14

15

16

17

Emergency department Outpatient department
NCHS Data Brief ■ No. 187 ■ February 2015

■  6  ■

Summary

Adoption of EHRs by hospital EDs and OPDs has increased. From 2006 through 2011, use of 

EHR systems increased significantly. In 2011, 84% of EDs and 73% of OPDs used an EHR 

system.

From 2007 through 2011, the percentage of hospitals reporting having an EHR system that met 

the criteria for a basic system increased among EDs (from 19% to 54%) and OPDs (from 9% to 

57%).

The HITECH Act of 2009 gave hospitals monetary incentives to adopt EHR systems. To receive 

incentive payments through the Centers for Medicare & Medicaid Services, hospitals had to meet 

federal standards of “meaningful use” of EHRs in three stages. Payments for Stage 1 of the EHR 

Incentive Programs began in fiscal year 2011, and payments for Stage 2 began in fiscal year 2014. 

From 2007 through 2011, five EHR Stage 1 core set objectives for demonstrating meaningful use 

were consistently collected in NHAMCS. Four of these five objectives increased significantly 

in both EDs and OPDs from 2007 through 2011. In 2011, information on 9 of the 14 Stage 1 

Meaningful Use objectives was collected in NHAMCS. Using 2011 data, the year with the 

most complete data on hospital readiness to meet Stage 1 core set objectives for demonstrating 

meaningful use, this report found that 14% of EDs and 16% of OPDs had EHR technology able to 

support nine Stage 1 core set objectives.

This study is limited in that its estimate of hospital readiness for Stage 1 Meaningful Use 

objectives overestimates hospital readiness because NHAMCS only measures 9 of 14 objectives, 

and hospital departments are limited to EDs and OPDs. To receive Meaningful Use incentive 

payments, hospitals have to meet 14 core set objectives and 5 of 10 menu set objectives.

Definitions

Basic system: A system that had all of the following functionalities: patient history and 

demographics, patient problem lists, physician clinical notes, comprehensive list of patients’ 

medications and allergies, computerized orders for prescriptions, and ability to view laboratory 

and imaging results electronically (3). 

Demonstrating meaningful use: The Medicare and Medicaid EHR Incentive Programs provide 

incentive payments to hospitals as they demonstrate meaningful use of certified EHR technology. 

The Centers for Medicare & Medicaid Services established the objectives for meaningful use in 

three stages that hospitals must meet in order to receive an incentive payment (4). From 2011 

through 2012, hospitals could receive incentive payments if they demonstrated 14 of the Stage 

1 core objectives for meaningful use, and 5 of 10 menu set objectives. The full list of Stage 1 

objectives and measures is published (1,2). The Table presents Stage 1 Meaningful Use core set 

objectives and corresponding 2011 NHAMCS EHR survey items.
NCHS Data Brief ■ No. 187 ■ February 2015

■  7  ■

Table. Meaningful Use Stage 1 core set objectives and corresponding NHAMCS EHR survey items

Meaningful Use objective 2011 NHAMCS

Computerized provider order entry for medications Prescription order entry

Drug-drug and drug-allergy interaction checks Drug interactions or contraindication warnings

Record patient demographics Patient history and demographic information

Maintain up-to-date problem list of current and active 

diagnoses Patient problem list

Clinical notes include a list of current medications and 

Maintain active medication list allergies

Maintain active medication allergy list Combined with above category

Vital signs ...

Smoking status ...

Reminders for guideline-based interventions or 

Implement one clinical decision support rule and ability to screening tests and warnings of drug interactions or 

track compliance with rule contraindications provided

Calculate and transmit Centers for Medicare & Medicaid ...

Services quality measure

Electronic copy of health information ...

Clinical summaries Providing patients with clinical summaries for each visit

Exchanges clinical summaries electronically with other 

Exchange key clinical information providers

Privacy and security ...

... Category not applicable; no corresponding survey item.

NOTES: NHAMCS is National Hospital Ambulatory Medical Care Survey; EHR is electronic health record.

Data source and methods

The data for this report are from the 2006–2011 NHAMCS, an annual, nationally representative 

survey of EDs and OPDs in nonfederal, general, and short-stay hospitals. It is designed to 

produce national estimates of EDs and OPDs. NHAMCS is conducted by the Centers for Disease 

Control and Prevention’s National Center for Health Statistics. More details about NHAMCS 

methodology are available (5). 

Data analyses were performed using the statistical packages SAS version 9.3 (SAS Institute, 

Cary, N.C.) and SUDAAN version 10.0 (RTI International, Research Triangle Park, N.C.). 

Numbers presented in the text were rounded to the nearest integer for ease of interpretability.

About the authors

Eric Jamoom and Esther Hing are with CDC’s National Center for Health Statistics, Division of 

Health Care Statistics, Ambulatory and Hospital Care Statistics Branch.
NCHS Data Brief ■ No. 187 ■ February 2015

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References

1. Blumenthal D, Tavenner M. The “meaningful use” regulation for 

electronic health records. N Engl J Med 363(6):501–4. 2010.

2. Hing E, Hall MJ, Ashman JJ. Use of electronic medical records by 

ambulatory care providers: United States, 2006. National health statistics 

reports; no 22. Hyattsville, MD: National Center for Health Statistics. 2010. 

Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr022.pdf.

3. Hsiao CJ, Hing E, Socey TC, Cai B. Electronic health record systems and 

intent to apply for meaningful use incentives among office-based physician 

practices: United States, 2001–2011. NCHS data brief, no 79. Hyattsville, 

MD: National Center for Health Statistics. 2011. Available from: http://www.

cdc.gov/nchs/data/databriefs/db79.htm.

4. Centers for Medicare & Medicaid Services. EHR incentive programs: 

The official web site for the Medicare and Medicaid electronic health 

records (EHR) incentive programs. Available from: https://www.cms.gov/

Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.

html?redirect=/ehrincentiveprograms.

5. NCHS. National Hospital Ambulatory Medical Care Survey. Public-use 

data file documentation, 2001–2010. Available from: ftp://ftp.cdc.gov/pub/

Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/.

Suggested citation

Jamoom E, Hing E. Progress with electronic 

health record adoption among emergency 

and outpatient departments: United States, 

2006–2011. NCHS data brief, no 187. 

Hyattsville, MD: National Center for Health 

Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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