{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:44:40Z","timestamp":1782906280463,"version":"3.54.5"},"reference-count":69,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54 GM115458"],"award-info":[{"award-number":["U54 GM115458"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Great Plains IDeA-CTR Network"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Using 15 years of hospital survey data (2008-2023), we examined rural\u2013urban trends in electronic health records (EHR) adoption and advanced capabilities for data sharing, public health reporting, and care improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a repeated cross-sectional study using the American Hospital Association Annual Survey Information Technology Supplement (2008-2018, 2020-2023). We constructed hospital-year measures of basic and comprehensive EHR capability, certified EHR technology (CEHRT) adoption, and advanced functions in patient engagement, interoperability, public health reporting, and social determinants of health (SDOH). We compared rural and urban adoption using descriptive analyses, Cochran-Armitage trend tests, and logistic regression with clustered standard errors, adjusted for bed size, ownership, and census division.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 41\u00a0838 hospital-years (45% rural). Comprehensive capability rose from 2% in 2008 to 75% in 2020, and CEHRT was nearly universal by 2023. Rural hospitals lagged urban hospitals in adopting basic and comprehensive EHRs, with the gap peaking at 25% in 2016. By 2021-2023, most hospitals reported patient portals, interoperability, public health reporting, and SDOH capabilities. Rural hospitals remained 4%-15% behind urban peers in advanced functions, particularly interoperability, public health reporting, and SDOH data collection and use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Persistent rural\u2013urban gaps in advanced EHR use may limit interoperability, data-driven care, and public health reporting in rural settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EHR adoption is widespread, but substantial rural\u2013urban gaps persist in advanced EHR use. Support for advanced capabilities that enable data sharing, reporting, and data-driven improvement is needed to ensure that rural hospitals and communities benefit from digital transformation beyond adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocag043","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:47:20Z","timestamp":1774010840000},"page":"1354-1369","source":"Crossref","is-referenced-by-count":1,"title":["The digital divide in adoption and advanced use of electronic health records among US hospitals: rural versus urban disparities from 2008 to 2023"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-7845","authenticated-orcid":false,"given":"A Jerrod","family":"Anzalone","sequence":"first","affiliation":[{"name":"Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinting","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Reisher","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Frankel","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, College of Medicine, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jed R","family":"Hansen","sequence":"additional","affiliation":[{"name":"Nebraska Rural Health Association , Papillion, NE 68133,","place":["United States"]},{"name":"College of Nursing, Omaha Division, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol Reynolds","family":"Geary","sequence":"additional","affiliation":[{"name":"College of Nursing, Omaha Division, University of Nebraska Medical Center , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2026063015355192300_ocag043-B1","first-page":"1c","article-title":"The First Anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act: the regulatory outlook for implementation","volume":"7","author":"Goldstein","year":"2010","journal-title":"Perspect Health Inf Manag"},{"key":"2026063015355192300_ocag043-B2","volume-title":"Adoption of Electronic Health Record Systems Among U.S. Non-Federal Acute Care Hospitals: 2008-2015. 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