\u201cSomeone is sitting in the shade today because someone planted a tree long ago.\u201d<\/em><\/p>\n This\u00a0quote<\/a>\u00a0from Warren Buffett on investment portfolios could describe the evolution of patient engagement over the past decade. Much like a carefully built portfolio, the dividends from years of investments in health IT continue to emerge. It is useful to take stock of the dividends of our digitization efforts.<\/p>\n In our\u00a0first<\/a>\u00a0post in the\u00a0Digital Dividends<\/em>\u00a0blog series, we explored how more individuals than ever are accessing and using their health information online, especially those managing chronic conditions or a recent cancer diagnosis. In this post, we look at how U.S. hospitals are helping enable that access, with a focus on where policy priorities, patient demand, and industry efforts have aligned to deliver on the promise of digitalization.<\/p>\n Our recent\u00a0data<\/a>\u00a0brief shows widespread adoption of patient engagement capabilities among hospitals. Patients can now view, download, and transmit their health data; import records from other organizations into a patient portal; view clinical notes; access information via apps; submit patient-generated data; and securely message providers.<\/p>\n Figure 1. Non-federal acute care hospitals\u2019 adoption of nine patient engagement capabilities, 2024<\/p>\n Source: 2024 American Hospital Association Information Technology Supplement. After more than a decade of policy making and private-sector innovation, patient engagement has unfolded in three eras coinciding with evolving phases of policy: foundational, emerging, and advanced. These eras are not defined by adoption rates alone but by policies and innovations that set the stage for hospitals to invest in patient engagement capabilities.<\/p>\n The\u00a0Foundational Era<\/em><\/strong>\u00a0of patient engagement was spurred by the\u00a0HITECH Act<\/a>\u00a0and the\u00a0Promoting Interoperability Programs<\/a>\u00a0(formerly Meaningful Use), which incentivized hospitals to adopt and demonstrate meaningful use of certified electronic health record technology. Foundational patient engagement capabilities \u2013 such as viewing medical records and messaging providers \u2013were supported. In 2012, prior to the PI program, only\u00a024% of hospitals<\/a>\u00a0provided patients with the capability to electronically view their health information. In 2025, 80% of hospitals reported adoption of all four foundational capabilities (view, download, transmit, and message), with nearly all hospitals (99%) enabling patients to view their health information electronically.<\/p>\n The\u00a0Emerging Era<\/em><\/strong>\u00a0of patient engagement focused on expanding transparency and choice. This was driven by the 21st<\/sup>\u00a0Century Cures Act and reinforced by subsequent\u00a0Information Blocking<\/a>\u00a0regulations, which focus on reducing impediments to the access, exchange, or use of electronic health information. This era spurred hospitals\u2019 adoption of capabilities to enable patients to have electronic access to their clinical notes and access their health information electronically via smartphone health apps. Now, more than 4 in 5 hospitals report supporting patient access to their information via apps, with 70% enabling HL7\u00ae Fast Healthcare Interoperability Resources\u00ae (FHIR\u00ae) based app access.<\/p>\n We are now in our\u00a0Advanced Era\u00a0<\/em><\/strong>of patient engagement where hospitals are increasingly allowing patients to import and upload their own data, a key advancement in patient-centered care. Currently, less than half of hospitals enable this capability, which had not previously been driven by federal policy or incentives. Nevertheless, we note that there has been an upward trend in growth showing hospitals\u2019 readiness to support more connected patient access and engagement. The Trump Administration earlier this summer\u00a0announced<\/a>\u00a0progress toward building a smarter, more secure, and more personalized healthcare experience in partnership with innovative private sector companies.\u00a0Through its most recent Health Tech Ecosystem announcements, CMS also issued a\u00a0call to action<\/a>\u00a0urging exchange networks, payers, providers, and developers to move toward the \u201cadvanced era\u201d of patient engagement.<\/p>\n Figure 2. Non-Federal Acute Care Hospitals\u2019 Adoption of Foundational, Emerging, and Advanced Engagement Capabilities in Any Setting: 2021-2024<\/p>\n Source: 2021-2024 American Hospital Association Information Technology Supplement.<\/p>\n Notes: \u201cFoundational\u201d refers to hospitals with early core patient engagement capabilities (view, download, transmit, secure messaging); \u201cEmerging\u201d includes those that added newer Cures Act\u2013related capabilities (clinical notes and patient app access); and \u201cAdvanced\u201d covers capabilities not yet required or incentivized (data import and patient-generated data [PGD]). *Indicates statistically significant difference from the same group in the preceding year at the 5% level. For more details, see the\u00a0data brief<\/a>.<\/p>\n Since the onset of the COVID-19 pandemic, patients have come to expect a \u201cnew normal<\/a>\u201d regarding engagement with their health information. Demand for electronic access has surged, with patients now expecting near-instant access through smartphone apps. Our recent\u00a0brief<\/a>\u00a0shows that federal policies and incentives aimed at enhancing patient access and hospitals\u2019 achievements in offering these capabilities to patients have contributed to greater access and innovation.<\/p>\n Community hospitals are the primary source of care for many Americans, and hospitals have been crucial enablers of electronic health information access. However, these gains have not been uniform. The foundational capabilities are nearly universal across hospitals, but more advanced capabilities like importing records and patient-generated data still lag among lower-resourced hospitals. These variable returns reflect the differences in hospital resources and vendor capabilities and have downstream implications for the patient populations they serve.<\/p>\n Looking ahead, the federal government, working alongside the health IT community, provider groups, payers, patients, and other stakeholders, will continue the hard work of advancing patient empowerment. Policy support and technical progress will be essential to ensuring that all patients have access to the most impactful patient engagement capabilities. The health technology ecosystem\u00a0recent request for information<\/strong><\/a>\u00a0from CMS and ASTP\/ONC underscores the need to expand access to technologies that empower patients to make informed decisions. Public\u00a0responses<\/strong><\/a>\u00a0offer us insights into where we have made progress and where more work is needed. Above all, patients want reliable, secure, and user-friendly systems that work for them. As we reflect on these responses, they\u2019ll help us shape our policy priorities surrounding patient access to their health information.<\/p>\nThe Eras of Patient Engagement<\/h2>\n
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Notes: PGD= patient-generated data. For more details, please see the\u00a0data brief<\/a>.<\/p>\n![\"Bar](\"https:\/\/healthit.gov\/blog\/wp-content\/uploads\/sites\/4\/2026\/01\/Figure2.png\")
<\/figure>\nThe New Digital Health Norm<\/h2>\n
Variable Returns and Looking Ahead<\/h2>\n