Hospitals in Underserved Communities Less Likely to Adopt Health Information Technology

There is a significant and persistent gap in the adoption of health information technology (HIT), with hospitals serving socioeconomically disadvantaged communities less likely to adopt telehealth and health information exchange (HIE) functionalities, according to a study published in JAMA Health Forum.1 While the adoption of technologies like telehealth and HIE has increased steadily since 2018 across the board, hospitals in the most disadvantaged areas are still falling behind.

Hospitals in more socioeconomically disadvantaged HSAs were less likely to adopt health information technology and health information exchange functionalities in the cross-sectional study. | Image credit: NIKCOA - stock.adobe.com

HIT functionalities like telehealth-assisted treatment and postdischarge measures, HIE systems, and electronic data exchanges can improve access to timely care, especially in areas without nearby health centers, the authors explained. Additionally, HIE systems can mitigate redundancy in procedures and reduce care fragmentation. And in underserved communities, hospital-based HIT holds the potential to reduce health disparities.

“…Persistent challenges, such as limited technological infrastructure, insufficient funding, and lack of training opportunities, continue to hinder HIT adoption in under-resourced communities,” the authors wrote. “Telehealth services, such as telehealth-assisted postcare management, are especially difficult to implement in areas with lower socioeconomic status, where infrastructure gaps and scarce community resources present major barriers. These limitations contribute to ongoing disparities in care access, quality, and outcomes.”

HIE system adoption is also less likely among hospitals in disadvantaged areas, and socioeconomic deprivation is associated with lower engagement in interoperable data exchange. This is an especially prominent trend in areas where community partners lack the capacity to utilize electronic health information.2 Several policies have been introduced in an effort to address these challenges, and alternative payment models and workforce development initiatives aim to provide sustainable solutions to overcome barriers to HIT.1 

“Given persistent challenges and encouraging recent policy efforts to promote digital health equity, this is a timely moment to generate updated evidence on hospital HIT adoption,” the authors wrote.

Researchers examined data from the 2018 to 2023 American Hospital Association (AHA) Annual Survey and IT Survey with hospital service area (HSA)–level area deprivation index (ADI), linking hospital data with the ADI for each HSA. A total of 16,646 hospital-level observations and 9218 observations from HIE functionalities were included.

Hospitals in the most socioeconomically deprived HSAs were significantly less likely to have adopted HIT functionalities, including treatment-stage telehealth, postdischarge telehealth, and HIE capabilities for electronic data query and availability.

For treatment-stage telehealth, the marginal effect (ME) in the most deprived areas was −0.03 (95% CI, −0.06 to −0.01). The postdischarge telehealth ME was −0.03 (95% CI, −0.07 to 0.01), the electronic data query capability ME was −0.03 (95% CI, −0.06 to −0.01), and the electronic data availability ME was −0.06 (95% CI, −0.11 to −0.01). Overall, however, adoption of all HIT measures increased across deprivation levels in the study period, with a plateau in adoption following the COVID-19 pandemic.

Accountable care organization (ACO) participation was a strong predictor of HIT adoption across all outcomes in the study, with an ME of 0.02 for treatment-stage telehealth (95% CI, 0.01-0.03), 0.03 for postdischarge telehealth (95% CI, 0.01-0.05), 0.05 for electronic data query capability (95% CI, 0.04-0.07), and 0.07 for electronic data availability (95% CI, 0.04-0.10). 

“This study highlights the potential of value-based payment models, particularly ACOs, for promoting adoption of telehealth and HIE functionalities,” the authors wrote. “Our results suggest that ACO participation may enhance HIT infrastructure and is associated with higher telehealth and HIE adoption, even in socioeconomically disadvantaged HSAs. ACO-participating hospitals are incentivized to reduce costs and improve care delivery, often resulting in broader use of HIT services and greater investment in technology.”

The study had several limitations, including its cross-sectional design, which does not allow for identification of causal inferences, only associations. It also relied on self-reported data from the AHA and IT surveys, which are subject to recall bias and nonresponse bias, as response rates were low.

Still, the authors concluded that hospitals in more socioeconomically disadvantaged HSAs were less likely to adopt telehealth and HIE functionalities in the cross-sectional study. Adoption of HIT increased over time, which they noted as a reason to be optimistic, and they encouraged future research on specific ACO characteristics that support HIT adoption and improve care in diverse socioeconomic settings.

“Importantly, ACO participation appears to support telehealth and HIE infrastructure development, even in under-resourced settings,” the authors wrote. “To promote equitable access to digital health tools, policy efforts should focus on addressing socioeconomic barriers and expanding ACO participation in disadvantaged communities, creating the conditions necessary for broader, more equitable HIT adoption.”

References

1. Yan AS, Apathy NC, Chen J. Adoption of health information technologies by area socioeconomic deprivation among US hospitals. JAMA Health Forum. Published online September 5, 2025. doi:10.1001/jamahealthforum.2025.3035

2. Everson J, Patel V, Bazemore AW, Phillips RL Jr. Interoperability among hospitals treating populations that have been marginalized. Health Serv Res. 2023;58(4):853-864. doi:10.1111/1475-6773.14165