Disproportionate share hospitals, which serve more poor patients, are lagging behind other hospitals in adopting electronic health records, according to a new survey.

Researchers reported in Health Affairs that without federal funding this digital divide would continue – and expressed concern that any funding would actually reach these hospitals.

The study, which examined EHR use in 2,368 acute care hospitals, was supported by the Robert Wood Johnson Foundation and the federal Office of the National Coordinator for Health Information Technology. The research was lead by Ashish Jha, MD, associate professor at the Harvard School of Public Health, in collaboration with Massachusetts General Hospital and George Washington University.

"We have to find a way to close this digital divide and make sure these hospitals get the capital they need. If we don't, we risk widening gaps in care that will lead to higher costs and more inefficiency," said John Lumpkin, MD, senior vice president of RWJF's Health Care Group.

Jha and his colleagues were concerned that hospitals serving the poor may not receive the stimulus funding they should because of the way the law is interpreted and bonus payments are allocated. For example, DSH hospitals rely more on Medicaid than Medicare, so if cash-strapped states opt out of participating in funding their portion of Medicaid efforts, they will likely fall further behind in EHR adoption, authors say.

"Health information technology (HIT) is central to improving the quality and efficiency of healthcare in America. HIT is woefully inadequate throughout the healthcare system, but institutions that treat the most vulnerable patients have much less of it and this leads to worse care," said Jha.

"This is not an isolated issue. We are talking about one in every four hospitals – and they treat millions of patients. These hospitals will need a concerted effort from both national and state policymakers to avert a serious digital divide from emerging," Jha added.