This project will conduct a national survey of primary care physicians to provide current, policy-relevant data for designing targeted policies to promote expansion of health information technology (HIT) in diverse rural settings. HIT has been identified as a potentially valuable tool for improving the quality, safety and efficiency of rural health care. Over the last several years, national policy has also emphasized wide scale adoption of HIT as an important priority, with the goal of having electronic health records (a fundamental component of HIT) available to most Americans by 2014. Policies are needed because the health sector is substantially behind other industries in using information technology, and HIT adoption in the United States lags behind levels in many other nations. National Ambulatory Medical Care Survey (NAMCS) data for 2005 show 24.8% of metropolitan office-based physicians have electronic health records (EHRs), compared with only 16.9% of their nonmetropolitan counterparts. The proportion of physicians actually making substantial use of the systems appears to be far lower: only 10.1% of metropolitan physicians and 3.1% of their rural counterparts. Rural areas already experience significant health disparities, including limited access to health services, and uneven diffusion of EHRs risks exacerbating those disadvantages. Various barriers to EHR adoption have been suggested, including cost. Much of the currently available information, however, is based on studies that suffer from methodological limitations, and there is very little information on differences across the rural spectrum. Better data are needed, therefore, to craft targeted policies tailored to distinct rural needs.

Using a sample from a national medical practice database, stratified to assure adequate responses in more rural areas, surveys will be mailed to 5,200 primary care practices in all 50 states and the District of Columbia to assess use of various forms of HIT as well as physician perceived barriers to and facilitators of HIT adoption. The survey is adapted from other instruments already used for HIT assessments, with modifications reflecting recent recommendations for improving the quality of HIT adoption studies. Intensive follow-up will be conducted to maximize the number of physicians completing and returning the surveys. Findings will be analyzed using Rural-Urban Commuting Area (RUCA) classifications grouped into four categories (urban, large rural, small rural, and isolated) to illuminate differences between different types of rural areas, as well as between rural and urban medical practices. The study is expected to provide more precise information than is currently available on the degree to which HIT is being used, as well as interest levels and barriers to adoption among physicians who are not using the technology. It also will explore relationships between rural HIT and factors such as physician practice characteristics (including safety net providers) and community factors, such as poverty and minority population. Findings — which will be disseminated through a report, policy brief, conference presentations and journal articles — will be valuable in developing policies tailored to the circumstances of different types of rural communities. In addition, the survey instrument will be made available for future national monitoring of rural HIT adoption.

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