Non-Federal Acute Care Hospital Electronic Health Record Adoption, 2008–2024

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted, among other federal health IT priorities, to invest in health IT adoption and use among hospitals and office-based physicians. Beginning in 2011, some hospitals began to receive incentive payments to adopt health IT certified by the ONC Health IT Certification Program. Early measurement of EHR adoption used the “Basic EHR” definition, which included core functionalities determined to be essential to an EHR system.(1) Authorized by HITECH, the Health IT Certification Program was implemented in 2010, and measurement then began to track hospital adoption of certified health IT.(2) This data brief uses nationally representative survey data from the American Hospital Association (AHA) Information Technology (IT) Supplement to examine trends in hospital EHR adoption, how adoption varied by hospital characteristics, developer market share, and EHR use across inpatient and outpatient settings from 2008 through 2024. This brief also represents ONC’s final formal reporting of EHR adoption statistics for non-federal acute care hospitals. Although there is still work ahead to advance health IT, the data in this brief show broad, ubiquitous EHR adoption among non-federal acute care hospitals—a strong digital foundation to continue advancing health care through technology.

Highlights

• Non-federal acute care hospital adoption of EHRs grew rapidly from less than 10% in 2008 to near-universal adoption of 99% by 2018.
• Differences in certified EHR adoption across hospital characteristics in 2010 and 2018 had disappeared by 2024, with uniformly high levels of adoption across all hospitals.
• Use of the same EHR developer across inpatient and outpatient settings increased from 62% of hospitals in 2010 to 90% in 2024.
• The hospital EHR developer market became highly concentrated over this time period, with the top three developers’ share increasing from 35% in 2010 to over 80% in 2024.

Non-federal acute care hospital EHR adoption grew rapidly from less than 10% in 2008 to near-universal adoption of 99% by 2018.

Findings

• In 2008, fewer than 10% of hospitals reported use of an EHR that met the “Basic” EHR definition and 76% reported use of a fully or partially electronic system (i.e., “Any” EHR).
• In 2010, 89% reported use of a system by a developer that would certify a health IT product to the 2011 Edition (by the end of 2010 or in 2011).
• By 2018, 99% of hospitals reported use of a certified EHR and an EHR that the met the “Basic” EHR definition – an important measurement convergence indicating rapid adoption of both certified health IT and health IT that supports the key clinical and administrative capabilities defined in the “Basic” EHR definition.

Figure 1: Percent of non-federal acute care hospitals that reported use of an EHR, 2008–2024.

Source: 2008- 2024 AHA Annual Survey Information Technology Supplement.
Notes: Percentages are calculated among non-federal acute care hospitals. Hospitals have adopted “Any” EHR if they report that they use a “fully electronic” or “partially electronic” system to record patient health information. See the Definitions section for definition of terms.

Differences in EHR adoption across hospital characteristics in 2010 and 2018 had disappeared by 2024, with uniformly high levels of adoption across all hospitals.

Findings

• In 2010, prior to the start of the Health IT Certification Program, most hospitals (86%) reported use of an electronic system to record patient health information; however, only 33% of hospitals reported use of a fully electronic system, while half reported use of a mix of electronic and paper charting.
• In 2010, hospitals used a mix of electronic and paper charts at similar rates, while medium or large, non-profit or government owned, suburban-urban, and non-critical access hospitals reported using fully electronic systems at higher rates.
• By 2018, 99% of hospitals had adopted a certified EHR adoption with little variation among hospital characteristics. In 2024, the data showed no significant variation across hospital characteristics with adoption rates nearing 100%.

Table 1: Trends in EHR adoption, by hospital characteristics among non-federal acute care hospitals, 2010–2024.

Hospital Characteristics	Partially electronic system	Fully electronic system	Certified EHR	Certified EHR
	2010	2010	2018	2024
Overall	53.1%	33.1%	99.0%	99.4%
Bed Size
Small <100 beds (ref)	53.7%	26.4%	98.9%	99.3%
Medium 100-399 beds	52.2%	38.4%*	99.2%	99.7%
Large >400 beds	53.7%	42.8%*	99.8%*	99.7%
Ownership
For-profit (ref)	55.6%	20.0%	97.7%	98%
Non-profit	51.0%	38.9%*	99.6%*	99.7%
Government	56.7%	26.4%*	98.7%	99.7%
Location
Rural	55.1%	27.4%	98.8%	99.5%
Suburban-Urban	51.5%	37.6%*	99.3%	99.5%
Critical Access
Yes	52.7%	24.3%	98.7%	99.5%
No	53.2%	36.5%*	99.3%	99.4%
System Affiliation
Independent Hospital	56.1%	28.9%	98.7%	99.0%
Multi-Hospital System Member	50.7%*	36.4%*	99.3%	99.7%

Source: 2010–2024 AHA Annual Survey Information Technology Supplement
Note: Percentages are calculated among non-federal acute care hospitals The top row within each hospital characteristic is the reference group. *Indicates statistically significant difference relative to the reference group (p<0.05).

Use of the same EHR developer across inpatient and outpatient settings increased from 62% of hospitals in 2010 to 91% in 2024.

Findings

• In 2010, 62% of hospitals reported use of technology from the same EHR developer across both inpatient and outpatient settings.
• In 2024, over 90% of hospitals did so, and nearly all hospitals used a single instance of the EHR.

Figure 2: Percent of hospitals that used the same EHR across inpatient and outpatient settings, 2010–2024.

Source: 2010–2024 AHA Annual Survey Information Technology Supplement
Notes: Percentages are calculated among non-federal acute care hospitals. See Appendix Table 2, “Inpatient and Outpatient EHR/EMR” for question text and definition of terms.

The hospital EHR developer market became highly concentrated from 2010 to 2024, with the top three developers’ share rising from 35% to over 80%.

Findings

• In 2010, over 90% of hospitals reported use of fully or partially electronic systems. Eighty-nine percent of hospitals reported technology from a commercial developer who would certify a 2011 Edition certified health IT product.
• In 2010, Meditech was the leading developer with 23% market share. No other developer had more than 15% market share.
• Using Herfindahl–Hirschman Index as a measure, the market moved from moderately concentrated in 2010–2014 to highly concentrated from 2016 onward due to mergers and acquisitions. (Appendix Table 1)
• In 2024, three developers provided technology to over 4 in 5 hospitals with Epic as the market leader with half of all hospitals.

Figure 3: Market share of hospital EHR developers, 2010–2024.

Source: 2010–2024 AHA Annual Survey Information Technology Supplement. Notes: Data labels reflect percentages (%). Percentages are calculated among non-federal acute care hospitals. See the Definitions section for definition of terms.

Summary

Approaches to measure EHR adoption have varied as health IT policy has focused on the development and implementation of technology to digitize clinical care, information exchange, and patient access. The different measures provide a comprehensive lens into EHR adoption trends and how rapidly hospitals shifted from partly paper and electronic methods to fully electronic, certified EHRs in less than a decade. In 2008, DesRoches et al. created a model—the “Basic” EHR—to define “EHR”: the electronic capability to record patient demographics and clinical notes, order prescriptions electronically, view laboratory and imaging results electronically, etc.(1) ONC used the “Basic EHR” definition to measure EHR adoption across hospitals, health systems, and ambulatory settings beginning in 2008 and as the federal government implemented the HITECH Act after 2009. The Health IT Certification Program, authorized by HITECH, began to certify health IT products in 2010.(2)

In this brief, we examined all forms of technology adoption beginning in 2008 to measure changes before and after implementation of these programs. In 2008, though fewer than 1 in 10 non-federal acute care hospitals used a “Basic” EHR, 3 in 4 used some form of technology for limited use cases (Figure 1). This shows that most hospitals had some type of software that performed certain computerized functions; however, their adoption of more advanced functionalities to enable digitized clinical care, information exchange, and patient access was less mature. The inflection point came with HITECH-driven incentives. Beginning in 2010, hospitals began adopting health IT certified to the 2011 Certification Edition; by 2012, a measurable share had implemented certified EHRs—many having received incentive payments starting in 2011. As shown in Figure 1, certified EHR and “Basic” EHR adoption converged in 2018, closing the adoption gap in only a few years when nearly all hospitals, regardless of size and geography, had adopted an EHR. This upward trend indicates that since 2008, combined U.S. Department of Health and Human Services (HHS) and HITECH efforts successfully moved nearly all non-federal acute care hospitals towards adoption of certified EHR technology. The transformation towards the use of EHRs certified to HHS-adopted standards enabled patients access to their electronic medical record, data sharing with third-party technology and devices, and electronic methods of information exchange via networks, messaging, and APIs.(3-5)

With regards to health IT developer market share, there has been increasing consolidation since 2010, as several exits and acquisitions during this period resulted in a few dominant market leaders. Analysis of reported technology developers in 2010 showed that around 10 developers provided technology for 84% of hospitals and fewer than 10% of hospitals reported no technology at all (i.e., use of paper and analog methods alone). In 2010, the top three developers captured 35% of market share. By 2024, the three leading developers comprised over 80% of the market. One recent study examined market consolidation through 2021 and using the Herfindahl-Hirschman Index (HHI) found that the market was competitive prior to 2012, became moderately concentrated through 2014, and highly concentrated after 2018. We replicated that analysis and found that the index continues to increase, and the market is becoming more concentrated.(6, 7)

This consolidation, however, was driven by many factors. From 2012 to 2018, several companies merged or were acquired by competitors. The Cerner Corporation (now Oracle Health) acquired Siemens Healthcare in 2014, CPSI (now TruBridge) acquired Healthland in 2015, and Allscripts (now Veradigm) acquired McKesson’s hospital EHR products in 2017, resulting in the market share of six distinct competitors consolidating under three companies, contributing to market consolidation, as measured by HHI during this period. Additionally, we observe significant market share gained during this period by Epic, the market leader now. In 2010, more hospitals said they didn’t use any EHR (9.1%) than said they used Epic (8.7%). Since then, Epic—then used mostly by academic medical centers—grew from about 8% of market share in 2010 to nearly half of all hospitals by 2024. Nearly all this market share gain came from hospitals moving from legacy systems and commercial competitors or adopting an EHR for the first time. It is also worth noting that, although incentive payments paid out to hospitals to adopt certified health IT influenced some purchase decisions, all incentive payments were spent by the end of 2016, and market consolidation continued unabated through 2024. Although we do not examine other market forces, like broader consolidation of independent health care organizations into corporate systems, and how that played a role in technology selection over time, other research has found a relationship.(7, 8) Future research should investigate the drivers of consolidation and the impacts of a highly concentrated EHR market on patients and care delivery organizations.

Near-ubiquitous EHR adoption has made meaningful transformation of the health care experience possible— from near real-time patient access to medical records, to advanced health information networks connecting hospitals and providers nationwide. While EHR adoption laid the foundation, it is not a finish line. The hope is that EHRs will not simply be medical record databases, but rather platforms on which new, innovative applications can be built to supplement and improve care delivery. For this hope to be realized, data must be shared according to the legal strictures of the 2016 Cures Act legislation, which mandates that health care data be shared, privately and securely, for the benefit of the patient.  As information blocking remains widespread, the next revolution in health care will be ushed in by enforcement of the Information Blocking regulations and subsequent flow of data in the interest of the patient.

As nearly all hospitals now use an EHR meeting DesRoches’ original “Basic” EHR definition, attention must turn to what comes next. The computerized capabilities underpinning the future of digital health—artificial intelligence, application programming interfaces, and consumer-facing technology—depend on this digital foundation to drive continued advancement. Ensuring that certification, data standards, and regulatory requirements keep pace with innovation will be critical to realizing that potential. At the same time, the rapid consolidation of the EHR vendor market warrants closer examination. Understanding what forces shaped EHR vendor consolidation—and what a highly concentrated market means for care delivery and patient outcomes— remains an important area for future study.(7)

Definitions

Any EHR: Hospitals have adopted any EHR if they report that they use a “fully electronic” or “partially electronic” system to record patient health information. Partially electronic means that the hospital uses electronic methods to record information in some cases, while also using paper chart or paper methods in others. Fully electronic means that the hospital uses only electronic methods to record patient health information.

Basic EHR: Hospitals have adopted a basic electronic health record system with clinician notes when the main site of the hospital includes a computerized system with capabilities in the following areas: patient demographics, physician notes, nursing assessments, patient problem lists, electronic lists of medications taken by patients, discharge summaries, advanced directives, orders for medications, viewing laboratory results, and viewing radiology results. See Data Sources and Methods for additional information.

Certified EHR: Hospitals have possession of a certified electronic health record system if the EHR technology meets the technological capability, functionality, and security requirements adopted by the Department of Health and Human Services. Possession means that the hospital has a legal agreement with the EHR developer, but it is not equivalent to adoption. The ONC Certification Program began in 2011. Data exists beginning in 2011. See Data Sources and Methods for additional information.

Critical Access Hospital: Hospitals with less than 25 beds and at least 35 miles away from another general or critical access hospital.

Large hospital: Non-federal acute care hospitals of bed counts of 400 or more.

Medium hospital: Non-federal acute care hospitals of bed counts of 100-399.

Non-federal acute care hospital: Hospitals that meet the following criteria: acute care general medical and surgical, children’s general, and cancer hospitals owned by private/not-for-profit, investor-owned/for-profit, or state/local government and located within the 50 states and District of Columbia.

Rural hospital: Hospitals located in a non-metropolitan statistical area.

Small hospital: Non-federal acute care hospitals of bed counts of 100 or less.

System Affiliated Hospital: A system is defined as either a multi-hospital or a diversified single hospital system. A multi-hospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post- acute health care organizations.

Data Sources and Methods

Data are from the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey from 2008–2024. Since 2008, ONC has partnered with the AHA to measure the adoption and use of health IT in U.S. hospitals. ONC funded the AHA IT Supplement to track hospital adoption and use of EHRs and the exchange of clinical data.

The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital’s health IT (typically the chief information officer) was requested to provide the information via a mail survey or a secure online site. Non respondents received follow-up mailings and phone calls to encourage response.

The 2024 survey was fielded from April to September 2024. The response rate for non-federal acute care hospitals (N = 2,253) was 51 percent. For prior years, the response rates were between 54% and 65%.  A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, ownership, teaching status, system membership, and availability of a cardiac intensive care unit, urban status, and region. Hospital-level weights were derived by the inverse of the predicted propensity.

To better identify EHR developers and an accurate adoption rate, we analyzed multiple questions (Appendix Table 2) related to EHR adoption fielded in the IT Supplement from 2008–2024. In all survey years from 2010–2022, the survey asked questions related to adoption of any EHR (fully or partially electronic), whether it is certified (according to the Meaningful Use or HHS requirements), and their inpatient EHR/EMR developer. These questions informed our measurement of “Any” EHR adoption (i.e., fully or partially electronic systems) and “Certified” EHR adoption. In 2008 and 2010, a hospital who responded “Yes” to using a fully or partially electronic system to document and manage patient care was considered to adopt “Any” EHR. For estimates of “Certified” EHR adoption, we used responses to several of the survey questions to control for missingness or non-response. We started with the question asking about the name of the hospitals’ primary inpatient and outpatient EHR/EMR system. For hospitals who answered “other” with a write-in response, we checked to see if their response matches one of the EHR developer listed as a response option, or if it’s considered self-developed. We then match the clean list to the ONC Certified Health IT Product List (CHPL) data to see if the developer was certified or not, including tracking older developer names through mergers and acquisitions. As part of the data cleaning, we also imputed “yes” to certified in cases where the hospital didn’t provide a response to developer name but did respond to the question about EHR/EMR certification. Hospitals who didn’t respond to either the developer name question or the certification question were considered missing and excluded from the calculation. For measurement of “Basic” EHR adoption, we used questions fielded from 2008–2018, that asked hospitals to confirm specific “computerized capabilities” they had to adopted to perform various clinical and administrative tasks. See Appendix A1 in this data brief for a list of those functions used to measure “Basic” EHR adoption and additional measurement details.(9)

Data Availability

The complete American Hospital Association IT Supplement data is available from the American Hospital Association (AHA): https://www.ahadata.com/aha-healthcare-it-database. If you have questions or would like to learn more about the data source or these findings, you may contact ONC_Data@hhs.gov.

References

1. DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, et al. Electronic Health Records in Ambulatory Care — A National Survey of Physicians. New England Journal of Medicine. 2008;359(1):50–60.
2. Office of the National Coordinator for Health IT. About The ONC Health IT Certification Program 2025 [Available from: https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program.
3. Office of the National Coordinator for Health Information Technology. U.S. Hospital Adoption of Patient Engagement Functionalities.  September 2025.
4. Strawley C, Barker W. Hospital Use of APIs to Enable Data Sharing between EHRs and Third-Party Technology. Washington, D.C.: Office of the Assistant Secretary for Technology Policy February 2026.
5. Office of the National Coordinator for Health Information Technology. Methods Used by Hospitals to Engage in Interoperable Exchange.  February 2026.
6. U.S. Department of Justice. Herfindahl-Hirschman Index  [updated January 17, 2024. Available from: https://www.justice.gov/atr/herfindahl-hirschman-index.
7. Holmgren AJ, Apathy NC. Trends in US Hospital Electronic Health Record Vendor Market Concentration, 2012-2021. J Gen Intern Med. 2023;38(7):1765–7.
8. Holmgren AJ, Apathy NC, Kanter GP. Electronic health record market consolidation and implications for cybersecurity. Health Aff Sch. 2025;3(8):qxaf164.
9. Henry J, Y P, Searcy T, Patel V. Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015. Washington D.C.: Office of the National Coordinator for Health Information Technology May 2016.

Acknowledgments

The authors are with the Office of Standards, Certification, and Analysis, within the Office of the National Coordinator for Health Information Technology (ONC). The data brief was drafted under the direction of Mera Choi, Director of the Technical Strategy and Analysis Division, Vaishali Patel, Deputy Director of the Technical Strategy and Analysis Division, and Wesley Barker, Chief of the Data Analysis Branch.

Suggested Citation

Barker W, Chang W. Hospital Electronic Health Record Adoption, 2008–2024. Office of the National Coordinator for Health Information Technology. Data Brief: 83. June 2026.

Appendix

Appendix Table 1: Market share of developers of hospital EHRs, 2010–2024.

Developer Name	2010	2012	2014	2016	2018	2020	2022	2024
Allscripts/Veradigm	3.4%	3.5%	3.2%	2.8%	5.4%	5.1%	0.3%	0.4%
Cerner/Oracle Health	12.2%	12.3%	14.6%	21.2%	21.7%	21.2%	18.6%	20.1%
CPSI/Trubridge	9.3%	8.5%	9.2%	9.2%	8.7%	8.6%	7.7%	7.1%
Epic	8.7%	12.1%	19.9%	25.3%	30.6%	38.1%	46.8%	50.8%
GE Healthcare	1.3%	1.0%	0.6%	0.3%	0.2%	0.1%	0.0%	0.0%
Healthland	4.6%	4.8%	3.6%	3.1%	2.4%	0.0%	0.0%	0.0%
MEDHOST	4.8%	4.6%	4.1%	3.6%	3.3%	2.4%	2.3%	1.4%
McKesson	10.3%	10.4%	9.0%	7.0%	1.4%	0.3%	0.1%	0.0%
Meditech	23.3%	22.5%	24.5%	23.1%	21.5%	20.2%	17.6%	15.6%
Siemens Healthcare	6.1%	6.0%	5.5%	0.1%	0.1%	0.0%	0.0%	0.0%
No EHR	9.1%	7.0%	0.4%	0.3%	0.3%	0.2%	0.2%	0.1%
Other EHR	6.8%	7.4%	5.4%	4.2%	4.3%	3.8%	6.5%	3.7%
Herfindahl–Hirschman Index (HHI)	1102	1131	1473	1803	2017	2430	2948	3297

Appendix Table 2: Survey questions used for analysis, 2010–2024.

Question Text	Response Option
Type of EHR/EMR
Does your hospital use an EMR/EHR system(s)? Do not include billing/scheduling systems. (2010 Q7, 2012 Q10)	1 = Yes, fully electronic 2 = Yes, partially electronic 0 = No 3 = Do not know
EHR/EMR Developer Name
Who provides your primary inpatient EHR/EMR system? (2010 Q19a, 2012 Q14a) Who provides your primary outpatient EHR/EMR system? (2010 Q19b, 2012 Q14b)	See survey instrument for response options. https://www.ahadata.com/aha-data-resources
Which vendor below provides your primary inpatient EHR/EMR system? (2014 Q16a, 2016 Q20a, 2018 Q19, 2020 Q27, 2022 Q28, 2024 Q1)	See survey instrument for response options. https://www.ahadata.com/aha-data-resources
Certification
Do you possess an EMR/EHR system that has been certified as meeting the federal requirements for each of the 24 hospital (2010 Q13)	1 = Yes, fully electronic 2 = No 3 = Do not know 4 = Not applicable, we do not have an EHR in place
Do you possess an EHR system that has been certified as meeting the federal requirements for the hospital objectives of Meaningful Use? (2012 Q12, 2014 Q14, 2016 Q17)	1 = Yes 2 = No 3 = Do not know
Do you possess an EHR system that has been certified? (2018 Q18)	1 = Yes 2 = No 3 = Do not know
Does your hospital use an EHR system that has been certified? (2020 Q26a, 2022 Q26a)	1 = Yes 2 = No 3 = Do not know
Inpatient and Outpatient EHR/EMR
Do you use the same primary inpatient EHR/EMR system vendor (noted above) for your primary outpatient EMR/EHR system? (2014 Q16b, 2016 Q20b)	1 = Yes 2 = No 3 = Don’t know 4 = NA (2014 only)
Do you use the same primary inpatient EHR/EMR system vendor (noted above) for your primary outpatient EMR/EHR system? (2018 Q23a)	1 = Yes, share single instance 2 = Yes, but do not share the single instance 3 = No 4 = Do not know 5 = NA
Do you use the same primary inpatient EHR/EMR system vendor (noted above) for your primary outpatient EMR/EHR system? (2020 Q31a, 2022 Q31, 2024 Q3)	1 = Yes, share single instance 2 = Yes, but do not share the single instance/version 3 = No 4 = Do not know 5 = NA

Appendix Table 3: Trends in EHR adoption, by hospital characteristics among non-federal acute care hospitals, 2010–2024.

Hospital Characteristics	Fully or partially electronic system	Certified	Certified
	2010	2018	2024
Overall	89.0%	99.0%	99.4%
Bed Size
Small <100 beds (ref)	84.7%	98.9%	99.3%
Medium 100-399 beds	92.2%*	99.2%	99.7%
Large >400 beds	96.4%*	99.8%*	99.7%
Ownership
For-profit (ref)	78.7%	97.7%	98%
Non-profit	91.8%*	99.6%*	99.7%
Government	88.4%*	98.7%	99.7%
Location
Rural	86.1%	98.8%	99.5%
Suburban-Urban	91.3%*	99.3%	99.5%
Critical Access
Yes	83.6%	98.7%	99.5%
No	91.1%*	99.3%	99.4%
System Affiliation
Independent Hospital	89.4%	98.7%	99.0%
Multi-Hospital System Member	88.8%	99.3%	99.7%