Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Report: Hospitals with High Proportion of Poor Patients Are Slow to Adopt Electronic Health Records

By Melissa Attias, CQ Staff

October 29, 2009 -- U.S. hospitals that serve a high proportion of poor patients tend to lag behind in adopting electronic health records (EHRs), according to a Health Affairs report published Oct. 26 as a Web exclusive.

The report, entitled "Evidence of an Emerging Digital Divide Among Hospitals That Care for the Poor," also found that hospitals disproportionately serving the poor are associated with a lower quality of care. Those that had adopted electronic health records, however, did not appear to have a quality gap, the report said.

"These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients," the authors wrote in the report.

The 2008 study surveyed 3,747 acute hospitals that were members of the American Hospital Association and received responses from 2,368 of them, for a 63.2 percent response rate.

Researchers then used the hospitals' Medicare disproportionate-share hospital (DSH) indexes—which are used to identify hospitals eligible for additional Medicare payments for caring for poor patients—to recognize which hospitals disproportionately care for the poor. The Centers for Medicare and Medicaid Services assign each hospital a DSH index based on its fraction of elderly Medicare patients eligible for Supplemental Security Income and its fraction of non-elderly patients with Medicaid coverage, the report said.

According to the analysis, hospitals with a high DSH index cared for a much larger proportion of elderly black patients, elderly Hispanic patients and Medicaid patients and a significantly smaller proportion of Medicare patients, compared with hospitals with a low DSH index. High-DSH hospitals were also more often large, major teaching hospitals, for-profit and located in the South, the report said.

Examining 24 electronic clinical functions, researchers also found that high-DSH hospitals had lower rates of adopting electronic health records than low-DSH hospitals. High-DSH hospitals without the electronic systems cited inadequate capital significantly more often as a major barrier to adoption, the report said, compared with low-DSH hospitals lacking the system.

In addition, the study found modest differences in quality of care between high-DSH and low-DSH hospitals based on acute myocardial infarction, congestive heart failure, pneumonia, and surgical complication prevention data from the Hospital Quality Alliance program. When hospitals adopted electronic health records, however, the study found that the DSH index was not negatively associated with quality performance.

"Our results suggest that EHR systems may be helpful in reducing the disparities in care between high- and low-DSH hospitals," the authors concluded. "While the Obama administration and Congress seek to craft effective policies to stimulate the adoption and use of health IT, it will be critical to ensure that institutions that care for the most vulnerable Americans are not left behind."

Publication Details