Electronic health record adoption rates are on the rise among U.S. hospitals, with 75 percent of hospitals now having adopted at least a basic EHR system—up from 59 percent in 2013. However, small and rural hospitals continue to lag behind their larger, urban counterparts.

Those are among the findings of researchers who published the results of their analysis of 2014 American Hospital Association Annual Survey–IT Supplement data in the November issue of Health Affairs, concluding that nationwide hospital EHR adoption is “in reach” but requires attention to small and rural hospitals, which have “persistently lagged in their adoption rates.”

Researchers point out that since 2008 there has been more than a 10-percentage-point gap between small and large hospitals in adoption of at least a basic EHR system. As of last year, small hospitals had an EHR adoption rate of 68 percent, compared with 85 percent for large hospitals, while 66 percent of rural hospitals last year adopted at least a basic EHR system, versus 78 percent of urban hospitals.

Julia Adler-Milstein, lead author of the study and assistant professor in the School of Information and School of Public Health at the University of Michigan, argues that less financial and technical resources are to blame for the disparity in EHR adoption.

“Small and rural hospitals tend to have less money,” says Adler-Milstein. “But, the biggest piece is really the resources and expertise in terms of whether the people working there have enough ability to make EHR adoption a focal point. It’s a major organizational undertaking, and you really need to have staff who are very experienced in change management and also have the time to focus on it.”

Compounding the problem is that in 2015 hospitals participating in the Medicare portion of the EHR Incentive Program face financial penalties for not meeting meaningful use requirements. “For small hospitals participating in the Medicare Meaningful Use program, the inability to keep up with attestation deadlines in the penalty phase could create even greater challenges for resource-constrained hospitals by reducing payments,” researchers assert.

Also See: Meaningful Use Harder for CAHs to Achieve

In terms of Stage 2 meaningful use readiness in 2014, researchers found that 29 percent of critical access hospitals had the ability to meet all 16 core objectives compared to 45 percent for non–critical access hospitals.

To help these hospitals, Adler-Milstein recommends that policy makers consider additional tools to support them. For example, she makes the case that Regional Extension Centers have increased EHR adoption in critical access hospitals by providing outside technical assistance as well as system ownership and group purchasing arrangements.

“I think it may be time to focus those Regional Extension Centers and other programs on targeting the problems that are particularly vexing for small and rural hospitals,” advises Adler-Milstein. “It’s really about bandwidth, resources and expertise. For smaller organizations, they just don’t have the ability to take this on.”

Researchers also recommend that policy makers take a “closer look at whether there are systematic differences in the capabilities and resources available to small facilities that may point to the existence of specific meaningful-use criteria that are less feasible for them to achieve.” In addition, they believe “discussions of when and how to raise the bar in Stage 3 would benefit from an understanding of how small hospitals will fare.”    

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