The Massachusetts eHealth Collaborative and the New York City Primary Care Information Project have provided financial subsidies and extensive support to help hundreds of independent medical practices successfully adopt electronic health records. Their efforts address overcoming key barriers such as the amount of start-up funds needed, productivity lost during implementation, and the difficulty of choosing the right system. Their approaches differ: the Massachusetts project emphasizes continuity of care within selected communities; New York emphasizes improvements in preventive care and chronic disease management across a population. Both, however, offer valuable insights that can be applied elsewhere.

Many physicians face financial and organizational barriers that inhibit their adoption of electronic health record (EHR) systems. The 2009 Health Information Technology for Economic and Clinical Health Act included provisions to facilitate the transition from paper to electronic records, including Medicare and Medicaid incentive payments to support the adoption and meaningful use of EHR systems. It also created the Health Information Technology Regional Extension Center (REC) program to ease the barriers faced by primary care physicians and rural and critical-access hospitals seeking to implement EHRs. The 60 RECs will administer individualized assistance to primary care practices and rural and critical-access hospitals as they implement new EHR systems or upgrade existing ones. In aggregate, the RECs aim to help 100 000 primary care physicians, physician assistants, and nurse practitioners to effectively implement EHR systems and qualify for incentive payments for meaningful use. This article describes the rationale for the REC program and describes how the 60 RECs promote the meaningful use of EHR systems.

Objective. Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). Data Sources/Study Setting. Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. Study Design. Descriptive study of 62 REC programs. Data Collection/Extraction Methods. Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. Principal Findings. RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eightythree percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. Conclusions. RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement. Key Words. Health information technology, electronic health records, meaningful use, practice transformation, primary care providers Health information technology (health IT) is foundational to the pursuit of the three-part aim of achieving better care, better health, and reducing costs (Berwick, Nolan, and Whittington 2008;Buntin, Jain, and Blumenthal 2010). Despite the potential benefits of health IT, adoption of electronic health records (EHRs) has been slow (Blumenthal 2010). In 2008, only 8 percent of

(1) presentations; (2) trigger tapes; (3) small group message development exercises; (4) town meeting enactments; (5) role play; (6) video replays; (7) CD-ROM/Web-based materials; (8) pocket cards; and (9) behavior checklists. Triangulation of evaluation data from the various sources identified the following key findings: (1) teaching clinicians how to care for the community via the media is important, but not everybody can picture themselves in such roles; (2) objectives must be kept modest, focusing on key issues and a few prime lessons learned; (3) while even a brief intervention is likely to increase confidence, for many, the main impact lies in raising awareness and piquing interest; and (4) online and take-home resources can help extend learning from a brief session. Conclusion: Media and risk communication training is challenging, but essential for preparing the healthcare workforce.