Patient engagement tools reach tipping point, but rural facilities still lag behind

Nearly every U.S. hospital now lets patients view their medical records online and message their doctors digitally. But a new federal analysis reveals that the digital health revolution has left many smaller, rural hospitals struggling to keep pace with their urban counterparts. 

The findings come from a new data brief published in August by the Office of the Assistant Secretary for Technology Policy, which tracked how hospitals adopted patient engagement technologies between 2021 and 2024. The report shows that while basic digital tools have become standard across American hospitals, more sophisticated features remain out of reach for many facilities. 

A decade of regulatory push pays off

Federal mandates have driven much of this transformation. The 2009 HITECH Act’s “meaningful use” requirements and subsequent Promoting Interoperability Program rules forced hospitals to give patients electronic access to their health records. 

The strategy worked. By 2024, these core capabilities had become virtually universal: 99% of hospitals let patients view their records online, 96% allowed downloads, 84% supported electronic sharing with third parties, and 92% offered secure messaging with providers. 

The 21st Century Cures Act, which took effect in 2020, pushed hospitals further by requiring access to clinical notes and mandating that data be available through smartphone apps. Hospitals responded quickly: 95% now provide electronic access to clinical notes, 81% support app-based record access, and 70% offer apps built on the Fast Healthcare Interoperability Resources (FHIR) standard. 

Where progress stalls

But hospitals have been far less enthusiastic about adopting tools that go beyond regulatory requirements. Just over half (56%) allow patients to import records from other healthcare organizations, and only 62% support patient-generated data like blood glucose readings or weight measurements from fitness trackers. 

The hesitation reflects real challenges. Integrating patient-reported data into clinical workflows creates technical headaches and raises liability concerns. Many doctors worry about information overload, and studies have linked the growing volume of electronic messages to higher rates of physician burnout. 

The digital divide persists

The federal data exposes stark disparities in who gets access to these digital tools. Large hospitals and those affiliated with health systems consistently outpace smaller, independent facilities. Only 71% of independent hospitals offer app-based access compared with 86% of system-affiliated hospitals. The gap widens further for FHIR-enabled apps: 56% versus 76%. 

Choice of electronic health record vendor also matters enormously. Hospitals using Epic — the market leader — were far more likely to offer advanced features (92% for app access, 83% for FHIR apps) than those using competing systems (70% and 56%, respectively). 

These patterns mirror longstanding technology gaps in American healthcare. Rural and smaller hospitals have consistently lagged behind in EHR implementation, a divide that federal programs have struggled to close. The new data suggests those disparities persist even as digital health becomes table stakes for patient care. 

Pandemic reshapes patient expectations

COVID-19 accelerated these changes in ways that may prove permanent. When hospitals and clinics scrambled to adopt telehealth almost overnight, patients quickly grew accustomed to the kind of instant connectivity they already had with banks and retailers. 

Today’s patients expect to review test results online, exchange secure messages with providers, and connect fitness trackers or glucose monitors to their medical records. Hospitals that can’t meet those expectations risk losing patient trust, particularly among younger generations who view app-based services as standard. 

A National Academy of Medicine analysis described this shift as a “new normal” in healthcare delivery — one that’s unlikely to reverse. 

What comes next

For policymakers, the data tells a story of both success and unfinished business. Federal incentives and regulations have clearly worked to drive adoption of basic digital tools. But without similar pressure, more advanced capabilities remain spotty across the hospital landscape. 

The Office of the National Coordinator for Health IT continues to expand certification requirements for electronic health records, signaling that interoperability and patient access remain priorities. Yet smaller hospitals may struggle to invest in the infrastructure needed for features like patient-generated data integration without additional support. 

Meanwhile, the burden on clinicians continues to grow. The promise of digital engagement could backfire if it overwhelms already-stretched healthcare workers with more messages, alerts, and data to review. 

The federal analysis captures American healthcare at an inflection point. Over four years, hospitals have fundamentally changed how patients access their health information, reflecting a broader shift toward consumer-centered care. 

Yet the uneven adoption patterns and growing clinician workload suggest the transformation remains incomplete. As policymakers consider the next wave of interoperability rules, they face a challenge that goes beyond simply expanding access: How do you build a digital health system that’s equitable, sustainable, and supportive of both patients and the providers who care for them? 

The data shows we’ve made remarkable progress toward that goal. Whether we can finish the job may depend on how well we address the gaps that remain.