{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T22:29:57Z","timestamp":1766269797171,"version":"3.37.3"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We used 2014, 2018, and 2023 data from the American Hospital Association Annual Survey IT Supplement to measure differences in adoption rates (ie, the \u201cadoption gap\u201d) 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 \u201ccore\u201d clinical data analytics functionalities, 5 \u201ccore\u201d 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009&amp;lt;\u2009.01). 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\u2009&amp;lt;\u2009.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Some crucial patient engagement functionalities have reached near-universal adoption; however, policymakers should consider programs to support CAHs in closing remaining adoption gaps.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocae267","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T20:10:43Z","timestamp":1730923843000},"page":"71-78","source":"Crossref","is-referenced-by-count":4,"title":["Trending in the right direction: critical access hospitals increased adoption of advanced electronic health record functions from 2018 to 2023"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7775-8544","authenticated-orcid":false,"given":"Nate C","family":"Apathy","sequence":"first","affiliation":[{"name":"Health Policy & Management, University of Maryland School of Public Health , College Park, MD 20742,","place":["United States"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7939-6831","authenticated-orcid":false,"given":"A Jay","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Division of Clinical Informatics and Digital Transformation, University of California\u2014San Francisco School of Medicine , San Francisco, CA 94131,","place":["United States"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2849-9005","authenticated-orcid":false,"given":"Paige","family":"Nong","sequence":"additional","affiliation":[{"name":"Health Policy & Management, University of Minnesota School of Public Health , Minneapolis, MN 55455,","place":["United States"]}]},{"given":"Julia","family":"Adler-Milstein","sequence":"additional","affiliation":[{"name":"Division of Clinical Informatics and Digital Transformation, University of California\u2014San Francisco School of Medicine , San Francisco, CA 94131,","place":["United States"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5355-6043","authenticated-orcid":false,"given":"Jordan","family":"Everson","sequence":"additional","affiliation":[{"name":"United States Department of Health and Human Services , Washington, DC 20201,","place":["United States"]}]}],"member":"286","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"2024121616110544600_ocae267-B1","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":"2024121616110544600_ocae267-B2","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1093\/jamia\/ocab102","article-title":"A decade post-HITECH: critical access hospitals have electronic health records but struggle to keep up with other advanced functions","volume":"28","author":"Apathy","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"2024121616110544600_ocae267-B3","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/jamia\/ocx080","article-title":"Electronic health record adoption in US hospitals: the emergence of a digital \u201cadvanced use\u201d divide","volume":"24","author":"Adler-Milstein","year":"2017","journal-title":"J Am Med Inform Assoc"},{"key":"2024121616110544600_ocae267-B4","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1111\/j.1748-0361.2010.00359.x","article-title":"Meaningful use of health information technology by rural hospitals","volume":"27","author":"McCullough","year":"2011","journal-title":"J Rural Health"},{"author":"Pick","key":"2024121616110544600_ocae267-B5"},{"key":"2024121616110544600_ocae267-B6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jamainternmed.2020.5928","article-title":"Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US","volume":"181","author":"Patel","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2024121616110544600_ocae267-B7","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1377\/hlthaff.2020.01786","article-title":"Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States","volume":"40","author":"Patel","year":"2021","journal-title":"Health Aff (Millwood)"},{"key":"2024121616110544600_ocae267-B8","doi-asserted-by":"crossref","first-page":"e233883","DOI":"10.1001\/jamahealthforum.2023.3883","article-title":"Progress and persistent disparities in patient access to electronic health information","volume":"4","author":"Richwine","year":"2023","journal-title":"JAMA Health Forum"},{"year":"2021","author":"Moscovice","key":"2024121616110544600_ocae267-B9"},{"key":"2024121616110544600_ocae267-B10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.21037\/jhmhp-21-13","article-title":"The application of organizational slack to hospital system responsiveness during the COVID-19 pandemic","volume":"5","author":"McHugh","year":"2021","journal-title":"J Hosp Manag Health Policy"},{"key":"2024121616110544600_ocae267-B11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.7555\/JBR.34.20200112","article-title":"Challenges confronting rural hospitals accentuated during COVID-19","volume":"34","author":"Slonim","year":"2020","journal-title":"J Biomed Res"},{"author":"Pick","key":"2024121616110544600_ocae267-B12"},{"key":"2024121616110544600_ocae267-B13","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/1475-6773.12140","article-title":"The Health IT Regional Extension Center Program: evolution and lessons for health care transformation","volume":"49","author":"Lynch","year":"2014","journal-title":"Health Serv Res"},{"key":"2024121616110544600_ocae267-B14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.hjdsi.2013.10.003","article-title":"Electronic health records and technical assistance to improve quality of primary care: lessons for regional extension centers","volume":"2","author":"Boas","year":"2014","journal-title":"Healthc (Amst)"},{"key":"2024121616110544600_ocae267-B15","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1111\/1475-6773.13193","article-title":"Horizontal and vertical integration\u2019s role in meaningful use attestation over time","volume":"54","author":"Everson","year":"2019","journal-title":"Health Serv Res"},{"key":"2024121616110544600_ocae267-B16","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1001\/jama.2023.20358","article-title":"Hospital characteristics associated with social needs activities in the US","volume":"330","author":"Sandhu","year":"2023","journal-title":"JAMA"},{"key":"2024121616110544600_ocae267-B17","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/1468-0009.12653","article-title":"Provision of social care services by US hospitals","volume":"101","author":"Iott","year":"2023","journal-title":"Milbank Q"},{"author":"Resources for Critical Access Hospitals and Small Rural Hospitals","key":"2024121616110544600_ocae267-B18"},{"key":"2024121616110544600_ocae267-B19","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1093\/jamia\/ocaa090","article-title":"Reconsidering hospital EHR adoption at the dawn of HITECH: implications of the reported 9% adoption of a \u201cbasic\u201d EHR","volume":"27","author":"Everson","year":"2020","journal-title":"J Am Med Inform Assoc"},{"year":"2023","author":"Richwine","key":"2024121616110544600_ocae267-B20"},{"key":"2024121616110544600_ocae267-B21","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/jamia\/ocab268","article-title":"Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use","volume":"29","author":"Holmgren","journal-title":"J Am Med Inform Assoc"},{"key":"2024121616110544600_ocae267-B22","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1093\/jamia\/ocad141","article-title":"COVID exacerbated the gender disparity in physician electronic health record inbox burden","volume":"30","author":"Rotenstein","year":"2023","journal-title":"J Am Med Inform Assoc"},{"key":"2024121616110544600_ocae267-B23","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1001\/jama.2023.26584","article-title":"National trends in billing secure messages as e-visits","volume":"331","author":"Holmgren","year":"2024","journal-title":"JAMA"},{"key":"2024121616110544600_ocae267-B24","doi-asserted-by":"crossref","first-page":"e24118","DOI":"10.2196\/24118","article-title":"Factors influencing telehealth implementation and use in frontier critical access hospitals: qualitative study","volume":"5","author":"Haque","year":"2021","journal-title":"JMIR Form Res"},{"key":"2024121616110544600_ocae267-B25","first-page":"239","article-title":"The trillion dollar conundrum: complementarities and health information technology","volume":"6","author":"Dranove","year":"2014","journal-title":"Am Econ J: Econ Policy"},{"key":"2024121616110544600_ocae267-B26","doi-asserted-by":"crossref","first-page":"e257","DOI":"10.1136\/amiajnl-2013-002449","article-title":"Reliability and validity of the American Hospital Association\u2019s national longitudinal survey of health information technology adoption","volume":"21","author":"Everson","year":"2014","journal-title":"J Am Med Inform Assoc"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/32\/1\/71\/61201911\/ocae267.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/32\/1\/71\/61201911\/ocae267.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T16:11:16Z","timestamp":1734365476000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/32\/1\/71\/7879493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,6]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,11,6]]},"published-print":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocae267","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"type":"print","value":"1067-5027"},{"type":"electronic","value":"1527-974X"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,11,6]]}}}