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The Use of Health Information Technology in Seven Nations

The Issue

With Commonwealth Fund support, researchers examined rates of use of electronic health records (EHRs) in ambulatory care settings and hospitals, as well as health information exchange activities, in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

What the Study Found

Based on a literature review and interviews with experts in each of the nations, the researchers found that:

  • In four countries—Australia, the Netherlands, New Zealand, and the United Kingdom—there is nearly universal use of EHRs by general practitioners (>90%). Forty percent to 80 percent of German general practitioners use EHRs.
  • Only 10 percent to 30 percent of ambulatory care physicians use EHRs in the United States and Canada. 
  • Although the available data are limited, the authors estimate that few hospitals in any of the seven nations—less than 10 percent—had the key components of an EHR in place. 
  •  Laying the infrastructure for health information exchange (HIE)—through which clinical data can move from one provider to another—is a high priority in all seven countries, though most efforts are in the early stages.


The authors point to several levers that have effectively increased EHR adoption: direct financial support, quality-of-care incentives, and requirements that computers be used for administrative tasks. Finally, the authors conclude, “only nations willing to invest significant financial resources and undertake the difficult work of creating standards and interchanges will reap the benefits of HIE for their citizens in the near future.”

Publication Details



A. K. Jha, D. Doolan, D. Grandt et al., “The Use of Health Information Technology in Seven Nations,” International Journal of Medical Informatics, Dec. 2008 77(12):848–54.