In a recent study, researchers Harvard School of Public Health, Mathematica Policy Research, and elsewhere, have discovered that while there has been an uptick in the number of hospitals adopting of EHRs, there is also a growing gap in the adoption of at least a basic record system based on size and location. Small, non-teaching, and rural hospitals continue to lag behind other types of hospitals, according to the study, which recently appeared in Health Affairs.

The authors of the study used data from the American Hospital Association annual survey of health information technology adoption from the period 2008–11 to see what proportion of US hospitals had a basic or comprehensive EHR system or could meet our proxy standard of meaningful use. Using a weighted approach, the researchers found 18 percent of hospitals had at least a basic EHR system in 2011, up from 11.5 percent in 2010. They were also likely to be a large, major teaching hospital, located in the northeast.

The researchers also said the gap between those hospitals that have adopted at least a basic EHR system increased substantially based on hospital size, teaching status, and location. The gap was 15 percentage points in 2010 (25.7 percent compared to 10.7 percent) and in 2011, it ballooned to 22.2 percentage points (20.8 percent compared to 43.0 percent, respectively). Hospitals in rural areas, according to the researchers, had the lowest growth spurt of any group.

Furthermore, the researchers found that even though the number of hospitals who could achieve Stage 1 of meaningful use increased substantially, more than 80 percent of hospitals they surveyed still could not do so. Most of those who reached in 2011, the researchers say, were those already close to reaching in 2010, and there is a widening gap there as well.

As a result of this gap, the researchers suggest policy makers “need to redouble their efforts among hospitals that appear to be moving slowly or starting from a lower base rate of adoption.” They say regional extension centers need to demonstrate their effectiveness.