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Digital Patient Data Access Grows in Large Hospitals, Lags in Small Orgs

Small organizations are lagging behind in offering digital patient data access via API-based apps, particularly apps built using FHIR.

Digital patient data access remains somewhat stable in the nation’s hospitals, with modest gains in patient portal and FHIR-based app access, according to an October data brief from the Office of the National Coordinator for Health IT (ONC).

However, digital patient data access isn’t equal across all hospitals and health systems. Rural hospitals, small hospitals, and critical access hospitals (CAHs) all have lower rates of digital patient data access, including via FHIR-based patient engagement apps and the patient portal, the report found.

Currently, 82 percent of all hospitals, regardless of size, let patients view their clinical notes in the EHR, meeting the terms of the 21st Century Cures Act.

This is more common among large hospitals, 87 percent of which offer patient portal access to clinical notes. That’s up from 2019—pre-Cures Act provision—when only 78 percent of medium and large hospitals enabled digital clinical note access.

Smaller hospitals are further behind in this. In 2021, the most recent year for which ONC has data, 76 percent of small hospitals—which include rural hospitals or CAHs—enabled patient portal access to clinical notes. Even still, that’s an improvement from before the Cures Act requirements, when only 72 percent of small hospitals offered digital access to clinical notes.

The ONC data brief showed a leveling off in app-based patient data access. In 2021, 70 percent of all hospitals let patients view their own health data in some kind of API-based app, the same share as in 2019. API data access was about the same among small hospitals, while medium and large hospitals actually saw decreases in how many offered patient data access via an API-based app, shrinking from 75 percent to 72 percent.

These figures could represent a plateau in API-based apps following 2019 rulemaking requiring hospitals to provide such technology. Notably, in 2018, only 46 percent of hospitals of any size offered this functionality, signaling the rule worked to spark widespread API-based app adoption at hospitals.

Hospitals are taking things a step further by using FHIR to build their apps, the data brief continued, with 55 percent of hospitals reporting as much. Zooming in specifically on the 70 percent of hospitals offering any kind of app, four in five said that app utilizes FHIR APIs.

Again, FHIR apps are a lot more common in large hospitals, with 61 percent saying they use FHIR to build their patient data access apps. Only 48 percent of small hospitals said the same, while small hospitals were more likely to say they have a non-FHIR app or no app at all.

CAHs, rural hospitals, and independent hospitals were also more likely to say they do not offer a FHIR-based app or any patient engagement app at all.

Moreover, there’s a big difference in app adoption among hospitals with different levels of sophisticated health IT. For example, hospitals with 2015 Edition Certified Health IT were more likely to offer patient data access via an app than those without 2015 Edition Certified Health IT.

Additionally, hospitals that use bigger EHR vendors were more likely to offer patient data access via an app, with 79 percent saying as much. This compares with 17 percent of hospitals with mid-level EHRs saying they have a patient data access app and only 4 percent with bottom-tier EHRs saying the same.

ONC did not specify which EHR vendors fell into which tier.

This progress comes after eight years of federal focus on digital patient data access. Starting in 2014 as part of the Medicare and Medicaid EHR Incentive Programs, otherwise known as meaningful use, hospitals receiving federal dollars were required to allow patients to digitally view, download, or transmit their own medical records. This primarily came in the form of the patient portal.

More recent developments have focused on simplifying that patient data access. The aforementioned 2019 rule required hospitals to offer patient data access using a patient-facing app built with an API connecting to the hospital EHR. Then, in 2020, rules required hospitals to build that app using FHIR. The 2020 rules, included as part of the 21st Century Cures Act, also required patients to have digital access to their clinical notes, a practice often referred to as open notes.

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