Apathy Nate C, Holmgren A Jay, Nong Paige, Adler-Milstein Julia, Everson Jordan
Health Policy & Management, University of Maryland School of Public Health, College Park, MD 20742, United States.
Division of Clinical Informatics and Digital Transformation, University of California-San Francisco School of Medicine, San Francisco, CA 94131, United States.
J Am Med Inform Assoc. 2025 Jan 1;32(1):71-78. doi: 10.1093/jamia/ocae267.
We analyzed trends in adoption of advanced patient engagement and clinical data analytics functionalities among critical access hospitals (CAHs) and non-CAHs to assess how historical gaps have changed.
We used 2014, 2018, and 2023 data from the American Hospital Association Annual Survey IT Supplement to measure differences in adoption rates (ie, the "adoption gap") of patient engagement and clinical data analytics functionalities across CAHs and non-CAHs. We measured changes over time in CAH and non-CAH adoption of 6 "core" clinical data analytics functionalities, 5 "core" patient engagement functionalities, 5 new patient engagement functionalities, and 3 bulk data export use cases. We constructed 2 composite measures for core functionalities and analyzed adoption for other functionalities individually.
Core functionality adoption increased from 21% of CAHs in 2014 to 56% in 2023 for clinical data analytics and 18% to 49% for patient engagement. The CAH adoption gap in both domains narrowed from 2018 to 2023 (both P < .01). More than 90% of all hospitals had adopted viewing and downloading electronic data and clinical notes by 2023. The largest CAH adoption gaps in 2023 were for Fast Healthcare Interoperability Resources (FHIR) bulk export use cases (eg, analytics and reporting: 63% of CAHs, 81% of non-CAHs, P < .001).
Adoption of advanced electronic health record functionalities has increased for CAHs and non-CAHs, and some adoption gaps have been closed since 2018. However, CAHs may continue to struggle with clinical data analytics and FHIR-based functionalities.
Some crucial patient engagement functionalities have reached near-universal adoption; however, policymakers should consider programs to support CAHs in closing remaining adoption gaps.
我们分析了临界接入医院（CAH）和非临界接入医院采用先进患者参与和临床数据分析功能的趋势，以评估历史差距是如何变化的。
我们使用了美国医院协会年度调查信息技术补充资料2014年、2018年和2023年的数据，来衡量CAH和非CAH在患者参与和临床数据分析功能采用率（即“采用差距”）上的差异。我们测量了CAH和非CAH在采用6种“核心”临床数据分析功能、5种“核心”患者参与功能、5种新的患者参与功能以及3种批量数据导出用例方面随时间的变化。我们构建了2种核心功能的综合指标，并分别分析了其他功能的采用情况。
临床数据分析方面，CAH的核心功能采用率从2014年的21%增至2023年的56%，患者参与方面则从18%增至49%。2018年至2023年，两个领域的CAH采用差距均缩小（P均<0.01）。到2023年，超过90% 的医院已采用查看和下载电子数据及临床记录的功能。2023年，CAH采用差距最大的是快速医疗保健互操作性资源（FHIR）批量导出用例（例如，分析和报告：CAH为63%，非CAH为81%，P<0.001）。
CAH和非CAH采用先进电子健康记录功能的情况均有所增加，自2018年以来一些采用差距已缩小。然而，CAH在临床数据分析和基于FHIR的功能方面可能仍面临困难。
一些关键的患者参与功能已接近普遍采用；然而，政策制定者应考虑制定相关计划，以支持CAH缩小剩余的采用差距。
