Lower Electronic Health Record Adoption and Interoperability in Rural Versus Urban Physician Participants: a Cross-Sectional Analysis From the CMS Quality Payment Program

Authors

Alfred J. Anzalone, University of Nebraska Medical CenterFollow
Carol R. Geary, University of Nebraska Medical CenterFollow
Ran Dai, University of Nebraska Medical CenterFollow
Shinobu Watanabe-Galloway, University of Nebraska Medical CenterFollow
James C. McClay, University of Nebraska Medical Center
James Campbell, University of Nebraska Medical CenterFollow

Document Type

Article

Journal Title

BMC Health Services Research

Publication Date

2025

Volume

25

Abstract

BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 introduced the Meaningful Use program to incentivize the adoption of electronic health records (EHRs) in the U.S. This study investigates the disparities in EHR adoption and interoperability between rural and urban physicians in the context of federal programs like the Medicare Access and CHIP Reauthorization Act of 2015 and the 21st Century Cures Act.

METHODS: A cross-sectional analysis was conducted using the 2021 Quality Payment Program Experience Report Public Use File to compare EHR adoption and Promoting Interoperability scores (PISs) between urban and rural physician participants. Data were linked with the Certified Health IT Product List to assess certified EHR adoption and interoperability.

RESULTS: The study included 209,152 physician participants, 12% of whom practiced in rural communities. EHR adoption was significantly higher in urban (74%) than in rural areas (64%). Epic Systems dominated the market in both settings. Multivariable logistic regression indicated lower odds of EHR adoption among rural physicians (OR: 0.79, CI: 0.76-0.82). Rural physicians also had lower PISs (β: -3.5, CI: -4.1 to -3.0). Factors like extreme hardship, small practitioner status, and location in a health professional shortage area significantly impacted EHR adoption and PISs.

CONCLUSIONS: Significant disparities exist in EHR adoption and interoperability between rural and urban physicians. These disparities highlight the need for targeted interventions to enhance EHR adoption and interoperability in rural settings to ensure equitable access to healthcare technologies and improved patient outcomes across all communities.

MeSH Headings

Cross-Sectional Studies, Humans, Electronic Health Records, United States, Male, Female, Centers for Medicare and Medicaid Services, U.S., Meaningful Use, Physicians, Rural Health Services, Urban Health Services, Urban Population, Rural Population

DOI Link

10.1186/s12913-024-12168-5

ISSN

1472-6963

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Recommended Citation

Anzalone, Alfred J.; Geary, Carol R.; Dai, Ran; Watanabe-Galloway, Shinobu; McClay, James C.; and Campbell, James, "Lower Electronic Health Record Adoption and Interoperability in Rural Versus Urban Physician Participants: a Cross-Sectional Analysis From the CMS Quality Payment Program" (2025). Journal Articles: Epidemiology. 214.
https://digitalcommons.unmc.edu/coph_epidem_articles/214