{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:21:03Z","timestamp":1780593663843,"version":"3.54.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32HS026116"],"award-info":[{"award-number":["T32HS026116"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Despite broad electronic health record (EHR) adoption in U.S. hospitals, there is concern that an \u201cadvanced use\u201d digital divide exists between critical access hospitals (CAHs) and non-CAHs. We measured EHR adoption and advanced use over time to analyzed changes in the divide.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We used 2008 to 2018 American Hospital Association Information Technology survey data to update national EHR adoption statistics. We stratified EHR adoption by CAH status and measured advanced use for both patient engagement (PE) and clinical data analytics (CDA) domains. We used a linear probability regression for each domain with year-CAH interactions to measure temporal changes in the relationship between CAH status and advanced use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2018, 98.3% of hospitals had adopted EHRs; there were no differences by CAH status. A total of 58.7% and 55.6% of hospitals adopted advanced PE and CDA functions, respectively. In both domains, CAHs were less likely to be advanced users: 46.6% demonstrated advanced use for PE and 32.0% for CDA. Since 2015, the advanced use divide has persisted for PE and widened for CDA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>EHR adoption among hospitals is essentially ubiquitous; however, CAHs still lag behind in advanced use functions critical to improving care quality. This may be rooted in different advanced use needs among CAH patients and lack of access to technical expertise.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The advanced use divide prevents CAH patients from benefitting from a fully digitized healthcare system. To close the widening gap in CDA, policymakers should consider partnering with vendors to develop implementation guides and standards for functions like dashboards and high-risk patient identification algorithms to better support CAH adoption.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocab102","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T20:05:49Z","timestamp":1620677149000},"page":"1947-1954","source":"Crossref","is-referenced-by-count":50,"title":["A decade post-HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7775-8544","authenticated-orcid":false,"given":"Nate C","family":"Apathy","sequence":"first","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Regenstrief Institute, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Jay","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, San Francisco, California, USA"},{"name":"Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Adler-Milstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, San Francisco, California, USA"},{"name":"Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"key":"2021081407002694700_ocab102-B1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1056\/NEJMp0912825","article-title":"Launching HITECH","volume":"362","author":"Blumenthal","year":"2010","journal-title":"N Engl J Med"},{"issue":"8","key":"2021081407002694700_ocab102-B2","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1377\/hlthaff.2016.1651","article-title":"HITECH Act drove large gains in hospital electronic health record adoption","volume":"36","author":"Adler-Milstein","year":"2017","journal-title":"Health Aff (Millwood)"},{"key":"2021081407002694700_ocab102-B3","year":"2017"},{"key":"2021081407002694700_ocab102-B4","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1377\/hlthaff.2012.0153","article-title":"Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record 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