{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:57:21Z","timestamp":1776092241084,"version":"3.50.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources \u2013 small, rural, safety-net \u2013 are keeping up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Using 2008\u20132015 American Hospital Association Information Technology Supplement survey data, we measured \u201cbasic\u201d and \u201ccomprehensive\u201d EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital \u201cadvanced use\u201d divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR]\u2009=\u20090.58; P\u2009&amp;lt;\u2009.001) and at least 8 patient engagement functions (OR\u2009=\u20090.68; P\u2009=\u20090.02).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocx080","type":"journal-article","created":{"date-parts":[[2017,7,5]],"date-time":"2017-07-05T11:31:44Z","timestamp":1499254304000},"page":"1142-1148","source":"Crossref","is-referenced-by-count":328,"title":["Electronic health record adoption in US hospitals: the emergence of a digital \u201cadvanced use\u201d divide"],"prefix":"10.1093","volume":"24","author":[{"given":"Julia","family":"Adler-Milstein","sequence":"first","affiliation":[{"name":"Schools of Information and Public Health, University of Michigan, Ann Arbor, MI, USA"}]},{"given":"A Jay","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Schools of Information and Public Health, University of Michigan, Ann Arbor, MI, USA"}]},{"given":"Peter","family":"Kralovec","sequence":"additional","affiliation":[{"name":"Health Forum, Chicago, IL, USA"}]},{"given":"Chantal","family":"Worzala","sequence":"additional","affiliation":[{"name":"American Hospital Association, Washington, DC, USA"}]},{"given":"Talisha","family":"Searcy","sequence":"additional","affiliation":[{"name":"Office of the National Coordinator for Health Information Technology, Washington, DC, USA"}]},{"given":"Vaishali","family":"Patel","sequence":"additional","affiliation":[{"name":"Office of the National Coordinator for Health Information Technology, Washington, DC, USA"}]}],"member":"286","published-online":{"date-parts":[[2017,8,22]]},"reference":[{"issue":"5","key":"2020110612460830600_ocx080-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":"7","key":"2020110612460830600_ocx080-B2","first-page":"e273","article-title":"Early results from the hospital electronic health record incentive programs","volume":"19","author":"Adler-Milstein","year":"2013","journal-title":"Am J Managed Care."},{"issue":"12","key":"2020110612460830600_ocx080-B3","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1377\/hlthaff.2015.0992","article-title":"Electronic health record adoption in US hospitals: progress continues, but challenges persist","volume":"34","author":"Adler-Milstein","year":"2015","journal-title":"Health Affairs."},{"key":"2020110612460830600_ocx080-B4","volume-title":"Adoption of Electronic Health Record Systems among US Non-Federal Acute Care Hospitals: 2008-2015. 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