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This report characterizes the diffusion of use of electronic health records (EHRs). The author uses a series of interviews and surveys and an extensive literature review to investigate whether healthcare can duplicate the gains enabled by information technology seen in a number of prominent industries. To accomplish this, the report answers the following questions: What is the current diffusion of health information technology, especially EHR systems? How does EHR diffusion compare to innovations in other industries? What is such diffusion worth to society? And, what should the government do, if anything, to speed the adoption of EHR systems? The author finds that EHRs are diffusing at a rate consistent with other similar information technologies in other industries-rapidly in many segments of the healthcare industry yet more slowly in physicians’ offices. Labor productivity increases are being seen and speeding adoption may be beneficial. The author provides a broad list of possible policy options that may be suitable for further study: Coordinate EHR standards immediately; work to improve quality measurement to encourage adoption and thereby alleviate the dauntingly labor-intensive process of quality management by using automation; reduce network externalities to encourage more, and more effective, adoption of EHR; encourage vigorous competition and deregulation; encourage firms to use health information technology as a competitive weapon; decide whether EHR is a societal goal and, if it is, provide subsidies; encourage government intervention in an incremental way, with rapid review of results to evaluate policies and strategies and adapt quickly.

Table of Contents

  • Chapter One


  • Chapter Two

    What Is the Current Diffusion of HIT?

  • Chapter Three

    EHR Past and Future Diffusion in Relation to Other Innovations

  • Chapter Four

    The Potential Value of Wide HIT Diffusion

  • Chapter Five

    Should the Government Intervene to Speed Diffusion of HIT?

The research described in this report was conducted within RAND Health for a consortium of private companies, including Cerner, General Electric, Hewlett Packard, Johnson & Johnson, and Xerox.

This report is part of the RAND Corporation Monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND monographs undergo rigorous peer review to ensure high standards for research quality and objectivity.

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