The U.S. is undertaking a large-scale effort to increase the use of electronic health records (EHRs). The centerpiece of 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act is $30 billion in incentives to encourage doctors and hospitals to adopt and use EHRs according to a federally defined set of “meaningful use” criteria. The legislation was motivated by the expectation that EHRs would lead to higher-quality, lower cost care by avoiding inefficiencies, inappropriate care, and medical errors. Transitioning from paper-based processes to EHRs is both organizationally and technically complex, and we have little empirical evidence on whether certain approaches result in better outcomes. This project will leverage longitudinal national data on hospital IT adoption to characterize and better understand approaches to EHR adoption. We will then examine the impact on outcomes, assessing whether EHR adoption reduces cost and improves quality, and whether specific approaches to adoption result in greater gains.