Trending in the right direction: critical access hospitals increased adoption of advanced electronic health record functions from 2018 to 2023
Open accessAbstract
Objectives: We analyzed trends in adoption of advanced patient engagement and clinical data analytics functionalities among critical access hospitals (CAHs) and non-CAHs to assess how historical gaps have changed. Materials and Methods: We used 2014, 2018, and 2023 data from the American Hospital Association Annual Survey IT Supplement to measure differences in adoption rates (ie, the “adoption gap”) of patient engagement and clinical data analytics functionalities across CAHs and non-CAHs. We measured changes over time in CAH and non-CAH adoption of 6 “core” clinical data analytics functionalities, 5 “core” patient engagement functionalities, 5 new patient engagement functionalities, and 3 bulk data export use cases. We constructed 2 composite measures for core functionalities and analyzed adoption for other functionalities individually. Results: Core functionality adoption increased from 21% of CAHs in 2014 to 56% in 2023 for clinical data analytics and 18% to 49% for patient engagement. The CAH adoption gap in both domains narrowed from 2018 to 2023 (both P < .01). More than 90% of all hospitals had adopted viewing and downloading electronic data and clinical notes by 2023. The largest CAH adoption gaps in 2023 were for Fast Healthcare Interoperability Resources (FHIR) bulk export use cases (eg, analytics and reporting: 63% of CAHs, 81% of non-CAHs, P < .001). Discussion: Adoption of advanced electronic health record functionalities has increased for CAHs and non-CAHs, and some adoption gaps have been closed since 2018. However, CAHs may continue to struggle with clinical data analytics and FHIR-based functionalities. Conclusion: Some crucial patient engagement functionalities have reached near-universal adoption; however, policymakers should consider programs to support CAHs in closing remaining adoption gaps.
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These trends parallel previously reported digital divides in hospital adoption of health IT.
“These trends parallel previously reported digital divides in hospital adoption of health IT.35,36”
From Uptake of Generative AI Integrated With Electronic Health Records in US Hospitals (2025) · cites this paper as [35]
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- Authors
- Apathy, N. C., Holmgren, A. J., Nong, P., Adler-Milstein, J., & Everson, J.
- Affiliations
- University of Maryland, College Park (US)
- University of California, San Francisco (US)
- University of Minnesota (US)
- Division of Clinical Informatics and Digital Transformation, University of California—San Francisco School of Medicine , San Francisco, CA 94131,
- United States Department of Health and Human Services (US)
- Corresponding author
- Apathy, Nate C
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-11-06
- Volume
- 32
- Issue
- 1
- Pages
- 71-78
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC11648721
- OpenAlex
- W4404091179
- Cited by
- 5
- References
- 19
- Citations by year
- 2026: 1 · 2025: 4
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Licence
- public-domain
- Locations
- Journal of the American Medical Informatics Association (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- critical access hospitals, electronic health records, technology adoption, patient engagement, clinical data analytics, FHIR, adoption gap, rural hospitals, health IT policy
- MeSH terms
- Diffusion of Innovation, Hospitals, Humans, Patient Participation, United States, Electronic Health Records
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