The lag in information exchange and assimilation adoption experienced by modern primary care physicians in the conduct of evidence based medicine may be affecting health care system productivity and patient quality of care. Further, interest in whether or not information technology (IT) investments show an increase in business value has increased in importance in response to the dynamic global market environment. Correspondingly, advances in information technologies are testing the ability of business managers to effectively combine and align available IT capabilities with the firm's strategic business plan to enable increased performance and contribute to sustained competitive advantage. As a result, management concern over the most appropriate use of limited fiscal, personnel, training, hardware, software, and consulting resources to maintain sufficient ROI has lead to concerns of the productivity impact and complementarities IT intensive systems may present. The relationship of electronic medical record (EMR) utilization to integrated health care delivery system (IHCDS) productivity as modified by firm constructs of "strategic alignment", "IT flexibility", and "IT infrastructure" was investigated. From this research it was found that productivity measures of annual patient counts, annual radiological procedures, and annual revenue per physician showed a positive correlation to the percentage of the operating budget allocated to information technology infrastructure spending in IHCDS in the United States. Insufficient evidence was found to support a correlation between the maturity of an IT strategic plan with these productivity measures. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]