Geographic differences in electronic health records implementation: The case of Alabama hospitals

Background: Rural areas in Alabama have a high concentration of African Americans, and experience disproportionately higher rates of chronic illness and mortality rates. Electronic Health Records (EHR) usage have potential benefits of improving communication between and among providers, helping to ensure continuity of health care, improving quality of care, and hence reducing health disparities in rural populations.

Objectives: 1) to assess the rural and urban differences perceived barriers, benefits, and driving factors in EHR implementation among Alabama hospitals; 2) to discuss the implications of exiting differences in EHR usage and the role of EHR in reducing geographic disparities.

Methods: A cross-sectional self-completed questionnaire was distributed to all health information management directors in 131 Alabama hospitals. Multivariate logistic analyses were used to analyze differences between rural and urban EHR usage and perceived barriers and benefits.

Results: Of 91 respondents, 58% were rural hospitals. Fewer rural hospitals (8%) have implemented EHR when compared with urban hospitals (18%). Rural hospitals were more likely than urban hospitals to report lack of support from medical staff (O.R.= 2.67) as a barrier to EHR implementation, but less likely to consider cost reduction (O.R.= 0.43) or meeting JCAHO/NCQA regulatory requirements (O.R.= 0.39) as driving factors of EHR implementation.

Discussion: Promotion of EHR implementation in rural areas is a challenging but necessary task that has potential implications of reducing health disparities between rural and urban populations. Understanding the existing differences between rural and urban areas in perceived barriers and driving factors of EHR implementation can facilitate policy interventions.