U.S. EHR Adoption and Interoperability
National physician and hospital trends, with a state-level look at where adoption still fails to translate into routine data exchange.
Physicians with any EHR, 2019
89.9%
+11.9pp since 2013
Adoption is close to saturation at the national level.
Send/receive patient info, 2019
42.4%
-47.6pp below any-EHR use
Exchange remains far below overall physician digitization.
Integrate external data, 2019
29.4%
-60.5pp below any-EHR use
Deeper interoperability lags even further behind exchange.
Rural hospitals with basic EHR, 2015
83.0%
-5.0pp vs national hospitals
Rural sites finish the continuous hospital series below the national curve.
State gap spread, 2015
38.1%
Largest minus smallest basic-to-exchange gap
State performance ranges from near-parity to wide interoperability shortfalls.
National trend
Physician adoption rose faster than interoperability
Basic and certified EHR adoption climbed quickly, but exchange and integration measures stayed materially lower once they began being tracked.
What stands out
Digitization is not the same as interoperability
Across the national physician series, adoption metrics rise first and reach much higher levels than interoperability metrics. By the end of the provided national series, physicians were far more likely to have an EHR than to exchange or integrate external patient information.
- The strongest drop-off is between broad EHR presence and true integration of outside clinical data.
- Certification improved digital readiness, but it did not erase the operational gap to real exchange.
How to read the views
Time windows differ by measure
The datasets do not track every metric in every year. The state comparison uses 2015 because it is the latest year in the provided physician state file with complete basic-EHR, send/receive, and integration measures across all states.
- The hospital comparison focuses on the continuous 2008-2015 basic-EHR series for national, rural, and small hospitals.
- The state scatter can toggle between exchange and integration to show where the gap widens further.
Gap comparison
Adoption outpaces exchange and integration
Grouped benchmarks compare the adoption baseline in each segment against exchange and integration activity in the same year.
Hospital comparison
Rural and small hospitals trail the national adoption curve
The national hospital basic-EHR line pulls away during the acceleration years, leaving rural and small hospitals a few percentage points behind by 2015.
State comparison
State comparison, 2015: basic EHR vs send/receive any patient info
Largest gaps
States with the widest 2015 basic-to-exchange gap
| State | Basic EHR | Send/Receive | Gap |
|---|---|---|---|
| Utah (UT) | 69.1% | 42.3% | +26.8pp |
| New Mexico (NM) | 72.6% | 47.2% | +25.4pp |
| North Dakota (ND) | 78.1% | 55.4% | +22.7pp |
| Montana (MT) | 67.2% | 45.5% | +21.7pp |
| South Dakota (SD) | 72.7% | 51.2% | +21.5pp |
Closest to parity
States with the tightest 2015 basic-to-exchange gap
| State | Basic EHR | Send/Receive | Gap |
|---|---|---|---|
| Massachusetts (MA) | 49.4% | 60.7% | -11.3pp |
| Arizona (AZ) | 50.4% | 61.4% | -11.0pp |
| Nevada (NV) | 40.5% | 49.0% | -8.5pp |
| Rhode Island (RI) | 46.9% | 54.3% | -7.4pp |
| Maine (ME) | 45.2% | 50.3% | -5.1pp |