Critical access hospitals lag behind in advanced EHR use functions

A study published this week in the Journal of the American Medical Informatics Association found that, although electronic health record adoption is essentially ubiquitous, critical access hospitals lag behind in advanced use functions.   

“As EHR adoption has become universal, the need to measure hospital use of advanced EHR functions that go beyond the digitization of clinical data to deliver value to patients clinicians grows increasingly important,” wrote the authors.   

“Our measures of advanced EHR use in the domains of patient engagement clinical data analytics show lower levels of adoption than basic EHRs,” they added.  


More than a decade after the passage of the Health Information Technology for Economic Clinical Health Act, basic EHRs are evenly distributed across various types of hospitals in the United States.  

Researchers note, however, that there was early evidence of a divide in which critical access hospitals were less likely than non-CAHs to have implemented patient engagement clinical data analytic tools.  

“Patient engagement tools facilitate efficient communication, improve access, enable interoperability for care coordination, while clinical data analytics capabilities give hospitals the ability to leverage the data in their EHRs for quality improvement, research, targeting high-risk patients with care management interventions,” wrote the researchers.  

“Both domains are integral to broader U.S. health system goals,” they added.

The team set out to examine whether that divide has persisted, examining the most recently available data from the American Hospital Association Annual Survey of Hospitals IT Supplement.  

The team found that in 2018, 98.3% of hospitals had adopted either a basic or comprehensive EHR, with no difference in adoption rates across CAH non-CAH hospitals.  

However, 63.3% of non-CAHs reported advanced EHR use for patient engagement, as compared with 46.6% of CAHs.

When it comes to clinical data analytics, 64.5% of non-CAHs reported advanced use, versus 32% of CAHs.

Between 2014 2018, the adoption gap for advanced use functions widened.   

The authors note that the HITECH Act included provisions focused on less-resourced hospitals, largely on facilities’ adoption of new EHRs, rather than on improving existing systems.

In addition, many patient engagement functions (such as appointment scheduling) are possible over the phone, so CAHs may not prioritize enabling them digitally. When it comes to clinical data analytics, workforce capacity constraints technical expertise may limit adoption.  

“Regardless of what is driving these gaps, they are problematic, as they have implications for patient care,” wrote researchers. “Specifically, without the tools to measure quality, stratify patient populations, more generally leverage clinical data from EHRs for organizational priorities, CAHs will likely struggle with undertaking tracking quality improvement efforts, as these capabilities are prerequisites to many quality improvement population health goals,” they continued.

In response, policymakers could allocate targeted support to promote advanced EHR use, as well as consider advanced analytic function implementation standards.  


More than ten years after the passage of the HITECH Act, stakeholders are contemplating lessons learned – reflecting on changes that could prevent future hiccups.

In a study published earlier this year, policy experts said that they had underestimated the impact of widespread EHR use on clinician burnout at the time of the law’s passage.  

On the other hand, fears around patient harm due to alert dependence identity theft were classified as overblown.  

The experts in that study also pointed to two unanticipated HIT outcomes over the past decade: EHR vendor monopoly minimal user experience improvement.  


“While EHR adoption has reached parity at a high level across U.S. acute care hospitals, the advanced use divide in advanced use among CAHs non-CAHs has not been diminished in recent years,” wrote researchers.  

“CAHs continue to lag in patient engagement functions, have fallen further behind in clinical data analytics. These functions underpin many quality improvement population health efforts, may prevent patients who receive care at CAHs from benefiting from a fully digitized healthcare system,” they added.


Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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