July 2021. As electronic health record adoption has expanded, an early “advanced use digital divide” was found among critical access hospitals, which were systematically less likely to have adopted advanced uses of EHRs for both patient engagement and clinical data analytics. Our study updates the evidence on this gap through 2018, and shows that while CAHs have caught up with other hospitals in terms of overall EHR adoption, they still lag in patient engagement capabilities and have fallen further behind in clinical data analytics. Only 47% of CAHs had achieved advanced use in patient engagement by 2018, and only 32% had achieved advanced use in clinical data analytics. This gap prevents CAH patients from reaping the full benefits of a digitized health care delivery system, and policies should target support for CAH advanced use via technical resources, vendor partnerships, and standards.