Rural safety-net hospitals lack advanced EHR capabilities, raising concerns about an emerging digital divide

Doctor typing on laptop
U.S. hospitals have achieved widespread EHR adoption, but an emerging gap could leave safety-net hospitals behind.

The majority of U.S. hospitals have adopted an EHR system as the entire industry is on pace transition to a digital system within the next four years.

But a worrying trend has emerged over the last several years: Far fewer critical-access hospitals have integrated advanced capabilities, raising concerns about an impending “digital divide” that disproportionately impacts small, rural facilities that care for low-income patient populations.

Eighty percent of hospitals across the country have adopted at least a basic EHR system, according to new research published this week in the Journal of the American Medical Informatics Association, up 5.3 percentage points since 2014. The incentive program established under the HITECH Act, passed in 2009 has been a primary driver behind getting hospitals to make the transition to electronic records.

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However, using survey data from the American Hospital Association, the study also showed that a smaller percentage of hospitals have upgraded to a “comprehensive” system.

Led by Julia Adler-Milstein, an associate professor at the University of Michigan, researchers with the AHA and the Office of the National Coordinator for Health IT found that 37.5% of hospitals adopted at least 8 of 10 performance measurement functions, such as patient safety monitoring and creating performance dashboards. Just over 41% integrated at least eight patient engagement functions like allowing patients to access their medical data and integrating patient-generated data.

Perhaps more concerning, the data indicated that small, rural and critical access hospitals were far less likely to adopt advanced functionality.

“This suggests the emergence of a digital ‘advanced use’ divide that may require new policy efforts to ensure that all hospitals translate EHR adoption into improved patient outcomes,” the authors wrote.

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Unsurprisingly, the study highlights upfront and ongoing costs as a barrier to adoption for critical access hospitals, and the researchers point to targeted incentives as a possible solution. But they also admit the gaps in adopting advanced capabilities are more nuanced since those same hospitals aren’t lagging when it comes to basic EHR adoption.

“It suggests that the IT and organizational capabilities necessary to support advanced use may be distinct from those required for EHR adoption, and safety-net providers may be specifically struggling to obtain the former,” the authors wrote.

A recent hospital payment rule finalized by the Centers for Medicare and Medicaid Services earlier this month could slow the adoption of advanced EHR adoption by giving hospitals the option to use 2014 Edition EHR certification in 2018 rather than upgrading to the 2015 edition, a move that was lauded by provider and health IT groups alike. 

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