Electronic health record (EHR) systems have positive effects on many dimensions of care process and outcomes. However, EHR adoption has been slow because of financial, organizational, and technological barriers. The Office of the National Coordinator for Health Information Technology (ONC) established the Regional Extension Center (REC) program, which set goals to support 100,000 providers with priority on providers working in small primary care practices, practices with a large proportion of patients with Medicaid or without insurance, community health centers, rural health clinics, and critical access hospitals. Funded by the ONC, AIR conducted a multiyear, mixed-method, independent national evaluation of the REC program.

AIR’s evaluation included conducting surveys and case studies of RECs and measuring the impact of the RECs through a matched comparison survey of participating and nonparticipating providers. While controlling for practice and county characteristics, the impact study analyzed administrative data collected by ONC and new data from a cross-sectional screening questionnaire and survey of primary care physicians. REC participation was positively associated with EHR adoption among primary care physicians working in small practices or practices with a large underserved patient base. Further, RECs appeared to serve a wide range of early and late EHR adopters. REC participation also was positively associated with receiving incentives. While 68 percent of REC participants received incentives for achieving stage 1 meaningful use, only 12 percent of nonparticipants did.