CAH EHR Adoption Lags Behind in Advanced Use, Clinical Analytics

Critical access hospital (CAH) EHR adoption lags behind in advanced patient engagement and clinical data analytics functions compared to non-CAHs, according to new research published in JAMIA that draws concern for the advanced use divide.

The researchers analyzed national EHR adoption statistics and found that in 2018, 98.3 percent of hospitals had adopted basic EHRs. When stratifying the data based on type of hospital, CAHs and non-CAHs showed equal EHR adoption.

However, the research revealed a divide in advanced use; CAHs were less likely to be advanced users in patient engagement and clinical data analytics functionalities.

In 2018, 58.7 percent and 55.6 percent of hospitals had advanced patient engagement and clinical data analytics functions integrated into their EHRs, respectively.

However, just 46.6 percent of CAHs demonstrated advanced use for patient engagement and only 32.0 percent showed advance use for clinical data analytics.

Since 2015, the advanced use divide has persisted for patient engagement features and widened for clinical analytics.

“These functions underpin many quality improvement and population health efforts, and may prevent patients who receive care at CAHs from benefitting from a fully digitized health care system,” the study authors wrote.

“Closing the gap between CAHs and non-CAH adoption of advanced EHR functions should be a priority for policymakers, targeting clinical data analytics functions,” the study authors wrote. “It may be appropriate to allocate resources to promote advanced EHR use among hospitals less equipped to pursue these functions independently.”

The research also revealed that CAHs that were part of a healthcare system were more likely to have patient engagement and clinical data analytics functions. The authors hypothesized that additional resources afforded to hospitals that are members of a care system, such as IT support staff, may explain this difference.

“These types of resources and support may be key to speeding CAH advanced EHR use,” the authors wrote.

In particular, the authors called for federal regulators to consider the development of EHR implementation standards. Additionally, they called for federal partnerships with EHR vendors to create best practices resources and common clinical analytics use cases.

“Development and dissemination of templates for building dashboards, high-risk patient identification algorithms, and clinician data querying tools would be of particular value, as CAHs trail far behind non-CAHs in these functions,” the authors explained. “This would help to close the advanced use divide, and support CAHs in their own internal quality improvement efforts and participation in delivery reform programs. “

Current efforts to encourage adoption of interoperability standards, such as ONC’s final interoperability rule which requires providers to adopt application programming interfaces (APIs) for patient access to data, will likely boost CAHs’ EHR patient engagement functionalities, the authors noted.

“Given that interoperability-based patient engagement functions are driving part of the advanced use divide, the 21st Century Cures Act Final Rule mandating the exchange of standard data elements via APIs should not be further delayed,” the researchers wrote.

“While these mandates may help close the gap in patient engagement functions, these are unlikely to be enough for some CAHs, so technical outreach efforts should focus on CAHs that have struggled to adopt APIs to date,” they explained.