International EHR Adoption

I was recently asked to compare EHR adoption in the US to other countries. Based on my own experience and the comments I received from colleagues, there are three aspects to consider:

* Use of Ambulatory EHR
* Use of Inpatient EHR
* Interoperability

Ambulatory
The most widely implemented are England, Denmark, Netherlands, and certain regions of Spain which are close to 100%. Sweden, Norway are at 80% and behind and Germany/France are at 50%. The US is somewhere between 2 and 20%, depending on how you classify a comprehensive EHR. Based on my definition - codified problem lists, e-prescribing, and decision support, the US is below 10% adoption.

Inpatient
Teaching institutions are generally well equipped, although less sophisticated on average than the US. Coverage in mid-low tier hospitals is high in England, Sweden, Norway, Denmark, and Finland, followed by Germany and Spain. In the US, CPOE adoption nationally is less than 25%

Interoperability
Denmark has the most signification implementation of production HIE with over 90% of encounters shared electronically. Certain regions in Spain, English, and Sweden have significant HIE. Canada Health Infoways has done excellent work with standards harmonization and incentivizing data exchange at the Province level. In the US, e-Prescribing is high is some states such as Massachusetts, Rhode Island and Nevada, but quite low in others. Clinical Summary exchange is done in some regions (Indiana, New York, Massachusetts, Tennessee, Minnesota, Arizona, Virginia) but most regions are just beginning implementation.

I've visited several sites in Sweden over the past 5 years, and the most innovative County is Jönköping

Qulturum is the organization in Jönköping that organizes the most innovative aspects of healthcare quality improvement including IT implementation.

As we think of lessons learned to guide US EHR installations, Scandinavia is definitely a region that has done IT right.

I welcome comments based on your own international experiences.