Refereed paper Record media used by primary care providers in medically underserved regions of upstate New York was not pivotal to clinical result in the Informatics for Diabetes Education and Telemedicine (IDEATel) project Philip C Morin MS IDEATel Administration Officer, Department of Medicine L Thomas Wolff MD Co-Investigator, Distinguished Professor Emeritus of Family Medicine SUNY Upstate Medical University, Syracuse, NY, USA Joseph P Eimicke MS Biostatistician, Research Division of the Hebrew Home at Riverdale, New York, USA Jeanne A Teresi EdD PhD Co-Principal Investigator, Gerontologist, Lead of Data Coordination Center, Research Division of the Hebrew Home at Riverdale, Bronx, Stroud Center, Columbia University, and New York State Psychiatric Institute, New York, USA Steven Shea MD MS Principal Investigator, Departments of Medicine, Epidemiology, and Biomedical Informatics, Columbia University, New York, USA Ruth S Weinstock MD PhD Co-Principal Investigator, Endocrinologist, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA and Department of Veterans Affairs Medical Center, Syracuse, NY, USA ABSTRACT Purpose To examine integration of electronic medical records (EMRs) by primary care providers (PCPs) in a diabetes telemedicine project (IDEATel) in medically underserved rural areas and assess if access to digital records is associated with diabetes intermediate outcomes. Method PCPs (n=61) with patients in IDEATel participated in structured interviews to determine current (2006 to 2007) and projected (2007 to 2008) use of paper and/or electronic medical data. T-tests examined group differences. Results 28% (17/61) of PCPs had comprehensive EMRs, but most electronic data were non- interoperative between offices; 6% of PCPs solely used paper; 92% of PCPs used mixed paper/electronic records. Half of 61 PCPs anticipated no migration within one year to an electronic record for common patient data, while one third anticipated that func- tion would become greatly more electronic. Among 31 PCPs interviewed in depth in person, 70% (7/10) in private practice and 69% (9/13) in networks anticipated greater electronic media migration through system change, whereas 100% of respond- ing academic PCPs (n=6) expected only system modifications. PCPs were most interested in data exchange for chronic disease management (94%), regional benchmarking (84%) and quality improve- ment (87%). Patient personal electronic health records Informatics in Primary Care 2009;17:103–12 # 2009 PHCSG, British Computer Society