title: Rural primary care practices and meaningful use of electronic health records: the role of Regional Extension Centers.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Casey
authors.forename: Ira
authors.initials: I
authors.lastname: Moscovice
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McCullough
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D004059:Diffusion of Innovation; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D062527:Meaningful Use; D008484:Medicaid; D006278:Medicare; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States
keywords: Medicare; electronic health records; policy; qualitative research; technology