While hospitals have widely adopted electronic health records systems in the years since the enactment of the HITECH Act, a digital divide has emerged in how those records systems are used, particularly by those healthcare organizations with fewer resources.

In fact, critical access hospitals are less likely to utilize advanced EHR functions for performance measurement and patient engagement—both of which are critical to improving the quality of care.

That’s the conclusion of new research presented on Monday at the 2017 American Medical Informatics Association Annual Symposium in Washington.

Researchers leveraged the latest national hospital data from the 2015 AHA Annual and IT Supplement survey to measure adoption rates of “basic” and “comprehensive” EHRs.

Also See: HITECH proves pivotal to hospital EHR adoption

“When we looked at what types of hospitals were more likely to achieve that comprehensive level of EHR adoption, perhaps not surprisingly it was larger hospitals, private not-for-profit hospitals, urban hospitals and hospitals participating in some type of payment or delivery reform effort,” said Julia Adler-Milstein, associate professor at the University of California-San Francisco and formerly with the University of Michigan.

According to Adler-Milstein, these hospitals “typically have been ahead of the curve in terms of EHR adoption” and are the “leaders” in moving from basic to comprehensive EHRs. At the same time, she noted that 62 percent of all hospitals surveyed cited the upfront costs of adoption as a major barrier as well as ongoing costs—with rural and smaller hospitals disproportionately likely to report these financial impediments.

In addition, the 2015 Supplement included newly available questions to assess hospital use of EHRs and EHR data for 10 quality improvement functions and 10 patient engagement functions.

Adler-Milstein reported that just 37.5 percent of hospitals adopted at least eight of 10 EHR data for performance measurement functions, and 41.7 percent of hospitals adopted at least eight of 10 patient engagement functions. However, she said the “bad news” is that critical access hospitals were much less likely to have adopted at least eight of the 10 performance measurement functions and at least eight of 10 patient engagement functions.

“We should be concerned about this emerging digital divide in terms of adoption of advanced functions” because EHR use for quality improvement and patient engagement is going to be essential for improving hospital performance, added Adler-Milstein. “We do need to consider what we can be doing to help safety-net hospitals make sure that they are able to continue their adoption trajectory and invest in some of these more substantive and important capabilities.”

She concluded that it’s not realistic to expect a “HITECH version 2.0” but policymakers should consider specific actions to target safety-net hospitals, which could include funding as well as technical assistance with their EHR implementations.

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