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Productivity gains from information technology coupled with complementary changes in organizational structure have been studied across an array of industries. Passage of the American Recovery and Reinvestment Act (ARRA), which allocated 30 billion dollars to stimulate adoption of electronic health record systems (EHRs), heightens the importance of this research in the health care setting. In this paper we examine the relationship between productivity, EHR use and delegation. Using data from 42 primary care practices that adopted an EHR, we find evidence that both greater EHR use and greater delegation increase productivity. We also find that EHR use and delegation operate as substitutes in increasing productivity with only low-delegation practices realizing gains from increasing EHR use.