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J Am Med Inform Assoc. 2018 Jun 1;25(6):654-660. doi: 10.1093/jamia/ocx135.

Are all certified EHRs created equal? Assessing the relationship between EHR vendor and hospital meaningful use performance.

Author information

Harvard Business School, Harvard University, Boston, MA 02163, USA.
School of Medicine, University of California, San Francisco, CA, USA.
School of Public Health, University of Michigan, Ann Arbor, MI, USA.



The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria.

Materials and Methods:

We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file. We used regression models to assess the relationship between vendor and hospital performance on 6 Stage 2 Meaningful Use criteria, controlling for hospital characteristics. We also calculated how much variation in performance is explained by vendor choice.


We found significant associations between specific vendor and level of hospital performance for all 6 meaningful use criteria. Epic was associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed, with some associated with significantly worse performance on multiple criteria. EHR vendor choice accounted for between 7% and 34% of performance variation across the 6 criteria.


A nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, and certain vendors are more often associated with better meaningful use performance than others. Our results suggest that policy-makers should improve the certification process by including more "real-world" scenario testing and provider feedback or ratings to reduce this variation. Hospitals can use these results to guide interactions with vendors.


Vendor choice accounts for a meaningful proportion of variation in hospital meaningful use performance, and specific vendors are consistently associated with higher or lower performance across criteria.


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