Rural adoption rates of electronic medical records overtake those in urban areas; the gap is more pronounced for specialists

Objective To assess rural – urban differences in electronic medical record (EMR) adoption among office-based physician practices in the U.S. Methods Survey data on over 270,000 office-based physician sites (representing over 1,280,000 physicians) in the U.S. collected by SK&A Information Services in 2012 was used to assess differences in EMR adoption rates between practices in rural and urban areas. Logistic regression tests for differences in the determinants of EMR adoption by geography, and a nonlinear decomposition is used to quantify how much of the rural – urban gap is due to differences in measureable characteristics (such as type of practice or affiliation with a health system). Results EMR adoption rates were significantly higher for practices in rural areas (56%) versus those in urban areas (49%) in 2012 (p<0.001). 29 states had significantly different adoption rates between rural and urban areas, with only 2 demonstrating higher rates in urban areas. EMR adoption continues to be higher for primary care practices when compared to specialties (51% vs 49%, p<0.001), and state-level rural-urban differences in adoption are more pronounced for specialists. The decomposition technique finds that only 14% of the rural – urban gap can be explained by differences in measurable characteristics between practices. Conclusions At the national level, rates of EMR adoption are higher for rural practices than for their urban counterparts, reversing earlier trends. This suggests that outreach efforts, namely the regional extension centers created by the Office of the National Coordinator, have been particularly effective for increasing EMR adoption in rural areas.