Rural Primary Care Practices and Meaningful Use of Electronic Health Records: The Role of Regional Extension Centers

Authors

  • Michelle M. Casey MS,

    Corresponding author
    1. Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
    • For further information, contact: Michelle M. Casey, MS, University of Minnesota Rural Health Research Center, 2520 University Avenue SE #201, Minneapolis, Minnesota 55414; e-mail: mcasey@umn.edu.

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  • Ira Moscovice PhD,

    1. Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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  • Jeffrey McCullough PhD

    1. Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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  • Funding: Support for this paper was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. 5U1CRH03717. The authors acknowledge Stratis Health, the North Carolina Area Health Education Center, Community Care of North Carolina, the North Dakota Health Care Review, the National Rural Health Resource Center and the University of North Dakota Center for Rural Health for sharing information about their experiences working with rural providers, and Caswell Family Medical Center, Dr. Karen Smith, Glacial Ridge Health System, and Midgarden Family Clinic for sharing information about their experiences implementing EHRs.

Abstract

Purpose

To examine the role of Regional Extension Centers (RECs) in helping rural physician practices adopt electronic health records (EHRs) and achieve meaningful use.

Methods

Using data from the Office of the National Coordinator for Health Information Technology, we conducted a county-level regression analysis using ordinary least squares to better understand rural-urban differences in REC participation, EHR implementation, and meaningful use, controlling for counties’ economic conditions. We prepared case studies of 2 RECs that are serving a large number of rural practices, based on interviews with key individuals at the RECs, their partner organizations, and rural primary care practices that received assistance from the RECs.

Findings

RECs are largely achieving their objective of targeting providers in communities that face barriers to EHRs. REC participants are disproportionately rural and more likely to come from high poverty and low employment communities. The case study RECs had long-standing relationships with rural providers, as well as extensive staff expertise in quality improvement and EHR implementation, and employed a variety of strategies to successfully assist rural providers. Rural providers report that REC assistance was invaluable in helping them implement EHRs and achieve meaningful use status.

Conclusion

Modifying the criteria for Medicare and Medicaid EHR incentives could help additional rural providers pay for EHRs. REC federal funding is scheduled to end in 2014, but practices that have not yet adopted EHRs may need significant, ongoing assistance to receive meaningful use.

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