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The basic use of Electronic Health Records EHR and the progression toward advanced EHR applications are key concerns facing leaders interested in integrating the healthcare delivery supply chain. Currently, substantial heterogeneity exists among hospitals in terms of EHR use and the progression toward advanced EHR applications. Understanding this heterogeneity is important as hospitals face pressure to adopt and achieve meaningful use of the technology. Contingency theory is tested herein to suggest that a hospital's structural constraints may explain the heterogeneity among hospitals in terms of their EHR use. Data collected from 297 acute care hospitals in 47 states reveals that critical access hospitals may be slow to use EHR, even in basic applications. Conversely, major teaching hospitals appear to be early adopters, achieving advanced EHR use. These findings are important for hospital executives, Health Information Technology managers, and policymakers concerned with directing resources with an aim toward EHR integration.