Though most hospitals, even in rural areas, have now adopted electronic health records (EHRs), a “digital divide” is growing between larger hospitals and critical access facilities in rural areas.

A study, published in the Journal of the American Medical Informatics Association, found 80.5 percent of hospitals have at least a basic EHR. When it comes to more advanced capabilities, like patient engagement and performance measurement, adoption has been slower: only 37.5 percent of hospitals reported adopting at least eight of 10 functions related to performance measurement, and 41.7 percent of hospitals had adopted at least eight of 10 patient engagement functions.

Critical access hospitals were less likely to have those advanced functions or even a basic EHR. Adoption seemed tied to the size of the hospital, with 55.5 percent of hospitals with more than 400 beds having a comprehensive EHR. For hospitals with fewer than 100 beds—which would include all critical access facilities—the rate was just 33.7 percent.

“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,” wrote Julia Adler-Milstein, PhD, a health IT researcher at the University of Michigan, and coauthors. “This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance.”

The high costs of adopting and implementing a more advanced EHR have become a fact of life for all hospitals and can lead to “significant financial risks” even for big facilities. Rural facilities, already strapped for cash, may not be able to bear the costs of upgrades.

Milstein and her coauthors suggested those critical access facilities pursue group purchasing arrangements to make buying more advanced EHRs more practical. For vendors, it recommended being more transparent about costs so these hospitals feel encouraged investing in more advanced capabilities will be worth the effort.