Background: Electronic Health Records (EHRs) have been widely promoted as tools for improving healthcare quality, operational efficiency, and institutional effectiveness. However, adoption and utilization remain uneven in many developing countries, including Nigeria, where infrastructural, financial, and organizational barriers persist. Objective: This study determined the extent of EHR adoption and utilization in selected secondary and tertiary healthcare institutions in Bayelsa State, Nigeria. Methods: A cross-sectional comparative design was employed. The study population comprised 3,312 healthcare professionals across 70 selected secondary and tertiary healthcare institutions. A sample of 344 was determined using Cochran's formula and adjusted using the finite population correction formula. Multistage sampling was used to select respondents. Data were collected using a validated structured questionnaire (Cronbach's α = 0.70) and analyzed using descriptive statistics with SPSS version 25. Results: Of 344 questionnaires administered, 331 were validly completed and returned (96.2% response rate). The composite mean score for EHR adoption and utilization was 2.80 (SD = 1.32), below the benchmark of 3.00, indicating low adoption. Only 48 respondents (14.5%) were from hospitals with fully adopted EHR systems, 22 (6.6%) from hybrid hospitals, and 261 (78.9%) from non-adopted hospitals. The lowest-rated items were availability of a dedicated IT team (M = 2.58) and adequate technical infrastructure (M = 2.65). Conclusion: EHR adoption and utilization remain low in secondary and tertiary healthcare institutions in Bayelsa State. The findings highlight the need for targeted investment in digital health infrastructure, technical support, and staff training.