Florida Atlantic University, United States.
Florida Atlantic University, United States.
Int J Med Inform. 2021 Jun;150:104441. doi: 10.1016/j.ijmedinf.2021.104441. Epub 2021 Mar 29.
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.
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.
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.
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.
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.
本研究旨在量化佛罗里达州医疗补助促进互操作性（PI）计划（前身为电子健康记录激励计划）中，激励计划实施一年后，医疗服务提供者参与的比例，并确定与“有意义使用”认证相关的提供者和实践特征。
我们使用 PI 计划（Provider Participation Database）2011-2018 年的记录进行了回顾性队列研究。使用卡方检验和 Mantel-Haenszel 卡方检验分别测试“有意义使用”与分类和有序变量之间的双变量关联，结果用于逻辑回归。报告调整后的优势比和 95%置信区间。
我们发现，在获得第一年激励后，42.56%的佛罗里达州医疗补助提供者实现了“有意义使用”。逻辑回归显示，儿科学者是实现“有意义使用”的最大比例的提供者（65.06%），而牙医的“有意义使用”比例最低（7.78%）。我们还发现，某些地理区域和各种电子健康记录供应商与提供者“有意义使用”认证的更高比例相关。
尽管 PI 计划成功地推动了基本电子健康记录系统的采用，但“有意义使用”的低认证率无意中在服务大量医疗补助患者的提供者之间造成了数字“高级使用”的鸿沟。这令人担忧，因为高级电子健康记录功能是解决未满足的社会经济需求以减少健康差异的必要前提。
佛罗里达州已向医疗补助提供者发放了超过 1 亿美元，这些提供者在获得第一年激励后最终并未实现“有意义使用”。需要采取政策干预措施，以促进高级电子健康记录使用功能，从而优化在资源有限的实践环境中使用技术的情况，在这些环境中，技术的潜在效益更大。
