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Study Objective: The US government provides financial incentives for "meaningful use" of health information technology, including computerized provider order entry. We assess prevalence of emergency department (ED) computerized provider order entry in 4 states, identify characteristics predicting computerized provider order entry adoption, and assess adoption in 1 state over time, all before incentive programs., Methods: We surveyed all nonfederal EDs in Massachusetts, Colorado, Georgia, and Oregon, assessing health information technology prevalence in 2008, focusing on computerized provider order entry, an enabler of other health information technology and a key element in itself. We use multivariable logistic regression to evaluate predictors of adoption. We compared the Massachusetts data with data from a similar survey we conducted for Massachusetts in 2005, using 95% confidence intervals (CIs) to assess the change in rate., Results: We identified and surveyed 351 EDs, and 290 (83%) responded to the computerized provider order entry module. Of these, 30% had adopted computerized provider order entry. Odds of computerized provider order entry in rural EDs were 0.07 relative to urban (95% CI 0.01 to 0.39). Oregon EDs had a higher likelihood of computerized provider order entry adoption than Georgia EDs, the state with the lowest adoption (odds ratio 2.9; 95% CI 1.2 to 7.3). In 2005, 15% of Massachusetts EDs reported computerized provider order entry versus 44% in 2008 (29% difference; 95% CI 26% to 32%)., Conclusion: Health information technology adoption varies by state and urbanicity, with less computerized provider order entry in rural EDs. ED computerized provider order entry adoption nearly tripled in Massachusetts from 2005 to 2008, before any financial inducements. Federal resources might be more effective if they helped providers select health information technology tools, improve health information technology design, and evaluate its influence on care delivery, versus simply calling for "more"., (Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)