Providers In Underserved Areas Lagging On EMR Implementation

Posted on July 11, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Providers in large metros are less likely to have implemented EMRs than those in smaller metro areas and rural areas, according to a study written up by Healthcare Informatics.

The study, which appeared in Health Services Research, set out to determine whether EMR adoption was lower in traditionally underserved areas. To look at this issue, in 2011 researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers, covering 50 states and the District of Columbia. Provider sites ranged from one-physician practices to large multi-physician groups, Healthcare Informatics reports.

Researchers found that areas with high concentrations of minority and low income populations, as well as those in large metropolitan areas were more likely to be in the lowest quartile of EMR adoption nationally, as compared with rural areas. The study also found that 43 percent of providers working in ambulatory healthcare sites had EMRs with e-prescribing capabilities, Healthcare Informatics reports.

Clearly, if researchers were expecting to find a lack of EMR adoption in these metro practices, they hit the nail on the head. I’d like to know, however, why things fell out this way.

Are metro practices lacking the resources to adopt EMRs in a more pronounced way than rural practices? Is there some phenomenon in the works in which underserved populations aren’t expecting EMRs, and therefore aren’t pressuring providers to implement them?

It’s worth noting that according to HIMSS data for Q1 2013, about 50 percent of ambulatory providers were still paper-based, and that nearly half of remaining practices were still stuck at Level 3 of adoption (CDR, access to results from outside facilities) or lower.

I’d argue that the gap between practices with mature implementations and those who are barely crawling is of equal importance and worth a study of its own. In the meantime, it is worth considering what can be done — beyond Meaningful Use incentives, clearly, or the gap wouldn’t exist — to be sure that EMR uptake doesn’t hit a snag with metro providers.