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ONC: As patient engagement tech soars, a digital divide opens

More organizations have adopted patient engagement technology capabilities, but have they also deepened a digital divide?

Sara Heath
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Published: 20 Aug 2025

Healthcare organizations are increasingly adopting foundational patient engagement technologies, but the industry might be falling victim to a digital divide between high- and low-resourced hospitals, according to the Office of the National Coordinator for Health IT and Assistant Secretary for Technology Policy.

Overall, hospitals nationwide have successfully implemented what ONC/ASTP referred to as "foundational patient engagement capabilities," or the ability to view, download and transmit one's own medical records.

In 2024, 99% of hospitals allowed patients to view their medical records, 96% to download and 84% to transmit. Moreover, 95% of hospitals enabled patients to view their clinical notes, which is a key provision in the 21st Century Cures Act, while 92% allowed patients to send secure direct messages to their providers.

Healthcare organizations are also making headway with what ONC/ASTP called "emerging patient engagement capabilities" such as letting patients access their health information using an API-powered app or access using a FHIR-enabled app.

Naturally, organizations have less progress in this area, but ONC/ASTP indicated these capabilities are growing. For example, inpatient access to apps grew from 68% in 2021 to 80% in 2024, reaching a high in 2023 at 83%. In the outpatient setting, access increased from 62% in 2021 to 75% in 2024.

Where most organizations fall behind is in what ONC/ASTP considered "advanced patient engagement capabilities," such as letting patients important their own medical data or patient-generated health data (PGHD). In 2024, only 45% of healthcare organizations had made advancements in these areas.

This isn't unsurprising. For one thing, ONC/ASTP considers patient data imports and PGHD engagement "advanced" for a good reason -- these functions are difficult to achieve.

But it could be more than that.

While capabilities like patient data access and access to clinical notes have been mandated through federal programs like the 21st Century Cures Act and the CMS Promoting Interoperability Program, functions like patient data imports have not. The lack of a federal mandate is likely due to the above-mentioned issue: facilitating patient data imports and PGHD is difficult and not a feasible ask for all organizations at this time.

Still, the growth in patient engagement capabilities is a key step forward for an industry recently calling for a better health tech ecosystem. However, there may be some unintended consequences stemming from these patient engagement tools.

Patient engagement tech disparities

It's important to note that there are some technology haves and have nots, ONC/ASTP said.

For example, small, rural, non-teaching, critical access and independent hospitals are all less likely to enable view, download and transmit capabilities for patients, the agency said. Similarly, organizations using smaller EHR and health IT vendors are less likely to offer these functions to patients.

"Differences in adoption by hospital characteristics underscore the role of vendor capabilities and organizational resources in shaping adoption of these important patient engagement capabilities," ONC/ASTP wrote in the data brief. "These differences may help explain the flattening in trends, suggesting that barriers, including technical, financial and operational, may limit progress."

If healthcare is to improve for all patients, it will be essential to better understand these disparities in patient engagement capabilities, the report authors continued. This, ultimately, amounts to a "techquity" mindset, meaning all patients have an equal opportunity to take advantage of health IT, regardless of where they access care.

Getting to digital health equity will require a better understanding of the technical, financial, operational and infrastructure limits that less-resourced organizations face.

"Findings indicate that U.S. hospitals have made major headway in foundational and emerging patient engagement capabilities, but gaps remain among lower-resourced hospitals," the report authors concluded. "It is important to support advancements in patient engagement capabilities while ensuring broader adoption of foundational digital health tools to advance nationwide engagement and achieve the goal of a patient-centric healthcare system."

Sara Heath has reported news related to patient engagement and health equity since 2015.

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