Revisiting the rural and urban divide in hospital health information technology adoption: Evidence from 2023

Abstract

Purpose: We assessed the adoption of telehealth, patient engagement (PE), and health information exchange (HIE) functionalities among hospitals in 2023, comparing adoption rates between rural and urban hospitals. Methods: We used the linked 2023 American Hospital Association Annual Survey and Information Technology Survey data. We examined average adoption rates of eight telehealth, eight PE, and three HIE functionalities across metropolitan, micropolitan, and rural acute care hospitals. Multivariate regression models were used to assess differences in adoption, adjusting for hospital characteristics. Findings: Rural and urban disparities in hospital health information technology (HIT) adoption persist in 2023. After adjusting for hospital characteristics, rural and urban differences in the likelihood of adopting any treatment-stage (e.g., psychiatric treatment and stroke care) or post-discharge (e.g., remote patient monitoring for chronic care) telehealth were not significant. However, overall, rural hospitals adopted an average of 0.24 fewer telehealth services (p < 0.05) and 0.25 fewer PE capabilities (p < 0.05). They were also less likely to have any HIE capabilities, relative to their urban peers. Conclusions: Although overall adoption of hospital HIT has increased since 2018 and some rural and urban gaps have narrowed, disparities remain in 2023. Rural hospitals continue to lag behind in the adoption of telehealth, PE, and HIE functionalities. Future research should explore barriers to adoption among under-resourced hospitals. Policy efforts must prioritize tailored strategies to support rural hospitals and promote broader access to HIT adoption nationwide.