The Impact of Market Factors on Meaningful Use of Electronic Health Records Among Primary Care Providers: Evidence From Florida Using Resource Dependence Theory and Information Uncertainty Perspective.

BACKGROUND: Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country. OBJECTIVE: Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology. RESEARCH DESIGN: Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers. MAIN OUTCOME: MU achievement after first-year incentives. INDEPENDENT VARIABLES: The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita. ANALYTICAL APPROACH: All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1). RESULTS: Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU ( P <0.001). Significant differences in MU achievements were obtained when we compared the "high" terciles with the "low" terciles for poverty rates ( P =0.002), health maintenance organization penetration rates ( P =0.02), and number of PCPs per capita ( P =0.01). These relationships were negative. CONCLUSIONS: Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.

The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers.

This study examines the impact of county-level factors on "meaningful use" (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011-2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.

Associations between Florida counties' COVID-19 case and death rates and meaningful use among Medicaid providers: Cross-sectional ecologic study.

Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated adoption of Electronic Health Records (EHRs) among Medicaid providers, only half achieved Meaningful Use. Furthermore, Meaningful Use' impact on reporting and/or clinical outcomes remains unknown. To address this deficit, we assessed the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level cumulative COVID-19 death, case and case fatality rates (CFR), accounting for county-level demographics, socioeconomic and clinical markers, and healthcare environment. We found that cumulative incidence rates of COVID-19 deaths and CFRs were significantly different between the 5025 Medicaid providers not achieving Meaningful Use and the 3723 achieving Meaningful Use (mean 0.8334/1000 population; SD = 0.3489 vs. mean = 0.8216/1000; SD = 0.3227, respectively) (P = .01). CFRs were .01797 and .01781, respectively, P = .04. County-level characteristics independently associated with increased COVID-19 death rates and CFRs include greater concentrations of persons of African American or Black race, lower median household income, higher unemployment, and higher concentrations of those living in poverty and without health insurance (all P < .001). In accordance with other studies, social determinants of health were independently associated with clinical outcomes. Our findings also suggest that the association between Florida counties' public health outcomes and Meaningful Use achievement may have had less to do with using EHRs for reporting of clinical outcomes and more to do with using EHRs for coordination of care-a key measure of quality. The Florida Medicaid Promoting Interoperability Program which incentivized Medicaid providers towards achieving Meaningful Use, has demonstrated success regarding both rates of adoption and clinical outcomes. Because the Program ends in 2021, we support programs such as HealthyPeople 2030 Health IT which address the remaining half of Florida Medicaid providers who have not yet achieved Meaningful Use.

Provider participation in the Florida Medicaid Promoting Interoperability program: Practice characteristics, meaning use attestations, and incentive payments.

OBJECTIVE: The objective of this study was to quantify the rate of provider participation beyond year 1 incentive in the Florida Medicaid Promoting Interoperability (PI) program, formerly the Electronic Health Record Incentive program, and identify the provider and practice characteristics associated with Meaningful Use attestations. METHODS AND MATERIALS: We conducted a retrospective cohort study using the 2011-2018 records from the PI program, Provider Participation Database. Bivariate associations between Meaningful Use and categorical and ordinal variables were tested using Chi-square and Mantel-Haenszel Chi-square, respectively, with results informing logistic regressions. Adjusted odds ratios and 95 % confidence intervals are reported. RESULTS: We found that 42.56 % of Florida Medicaid providers achieved Meaningful Use after receiving first-year incentives. Logistic regression showed that pediatricians represented the largest percentage of providers who achieved Meaningful Use (65.06 %) while dentists had the lowest Meaningful Use (7.78 %). We also found that certain geographic areas and various EHR vendors were associated with higher rates of providers Meaningful Use attestation. DISCUSSION: Although the PI program successfully influenced the adoption of a basic EHR system, low Meaningful Use attestations have inadvertently created a digital "advanced use" divide among providers who serve large numbers of Medicaid patients. This is concerning because advanced EHR functions are necessary precursors to address unmet socioeconomic needs to reduce health disparities. CONCLUSION: Florida has distributed over $100 million to Medicaid providers who ultimately did not achieve Meaningful Use after collecting their first-year incentive. Policy interventions that can promote advanced EHR use functions are necessary to optimize technology in low-resourced practice settings where the potential benefits are greater.

Characteristics of office-based providers associated with secure electronic messaging use: Achieving meaningful use.

OBJECTIVES: To identify characteristics of office-based provider used as a usual source of care (USC) associated with secure electronic messaging (SM) use. DATA SOURCE: 2015 Medical Expenditure Panel Survey Household Component and the supplemental Medical Organizations Survey. STUDY DESIGN: Cross-sectional analysis. EXTRACTION METHODS: Patients are linked to characteristics of their usual source of care provider. MAIN FINDINGS: We found that 89 percent of patients whose USC had electronic health records were able to exchange secure messages with their provider. Patients whose USC reported being patient-centered medical homes (PCMHs) or that used other health information technology (HIT) were also more likely to have been able to exchange SM with their provider. Patients of independent group or solo practices were less likely to have been able to exchange SM relative to patients whose USC practice was hospital owned. CONCLUSIONS: Patients were more likely to have visited a USC that exchanged SMs if that practice also used other electronic health records functionalities. Study findings suggest that while patients' USC practices were likely to exchange secure messages, there is a disparity in SM use between physician-owned practices, and hospital-owned practices.

Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State.

On October 1, 2012, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services began to reduce payments to hospitals with excessive rehospitalization rates through the Hospital Readmissions Reduction Program. These financial penalties have intensified hospital leaders' efforts to implement strategies to reduce readmission rates. The purpose of this multiple case study was to explore organizational strategies that leaders use to reduce readmission rates in hospitals located in a non-Medicaid-expansion state. The data collection included semistructured interviews with 15 hospital leaders located in five metropolitan and rural hospitals in southwest Missouri. Consistent with prior research, the use of predictive analytics stratified by patient population was acknowledged as a key strategy to help reduce avoidable rehospitalization. Study findings suggest that leveraging data from the electronic health records to identify at-risk patients provides comprehensive health information to reduce readmissions. Hospital leaders also revealed the need to understand and address the health needs of their local population, including social determinants such as lack of access to transportation as well as food and housing.

Analyzing the ICD-10-CM Transition and Post-implementation Stages: A Public Health Institution Case Study.

On October 1, 2015, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) was incorporated into the US public health system. Because of significant opposition and reservations expressed by stakeholders, while the proposed rule for ICD-10-CM adoption was issued in 2009, the transition did not occur until October 2015. The purpose of this study was to identify conversion initiatives used by a public health institution during the initial and subsequent stages of ICD-10-CM implementation, to help similar institutions address future unfunded healthcare data infrastructure mandates. The data collection for this study occurred from 2015 to 2018, encompassing 20 semistructured interviews with 13 department heads, managers, physicians, and coders. Research findings from this study identified several trends, disruptions, challenges, and lessons learned that might support the industry with strategies to foster success for the transition to future coding revisions (i.e., ICD-11).