Electronic medical record adoption in Oklahoma practices: rural-urban differences and the role of broadband availability.

Purpose: Most recent research has not found significant differences in electronic medical record (EMR) adoption rates between rural and urban physicians. However, few studies have assessed rural/urban differences at a lower level--for instance, by specialty or size of practice. Determinants of EMR adoption by physician practices in Oklahoma are explored, including the potential role of broadband availability (which is required for EMR interoperability).

Methods: Surveys of 2,800 unique Oklahoma physician practices in 2011 were meshed with data from the National Broadband Map for that same year. Summary statistics from the survey data allowed for comparison of EMR adoption rates by sub category. Logistic regressions were used to tease out the impact of location, specialty, and broadband availability on the EMR adoption decision.

Findings: Similar overall EMR adoption rates in rural and urban practices masked significant differences among specific subcategories. In particular, solo practices in rural areas are much more likely to adopt EMRs than are their urban counterparts (41% vs 33%, P < .01); rural psychiatric practices also have measurably higher adoption rates (59% vs 25%, P < .01). Logistic regression results demonstrate that determinants of adoption do vary between rural and urban practices. No statistical relationship between EMR adoption and measures of broadband availability was found.

Conclusions: Measurable differences in EMR adoption rates do exist between rural and urban practices for specific physician categories in Oklahoma. Targeted policies may be important for increasing EMR adoption, but policy efforts focusing solely on broadband availability for private practices are likely misguided.