Barriers to Meaningful Use in Medicaid (North Carolina)

Project Final Report (PDF, 682.31 KB)

Project Details - Ended

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Summary:

Providers who serve a high proportion of Medicaid-insured patients may have lower rates of electronic health record (EHR) use. This project looked at factors that might explain this finding, including specific features of the Medicaid Meaningful Use (MU) Incentive Program, and whether the program creates participation barriers for Medicaid providers. In particular, the project team looked at whether the work-environment or characteristics of the Medicaid population itself creates these barriers. It also looked at whether the Medicaid MU Incentive Program combined with available technical assistance is sufficient to mitigate these barriers. The ultimate goal of the project was to develop findings and recommendations to inform policy related to MU among Medicaid providers.

The objectives of this project were to:

  • Identify the barriers to eligibility for the incentive payments; barriers to adoption, implementation, or upgrading of EHR systems; and barriers to achieving meaningful use.
  • Develop actionable recommendations to overcome barriers identified above, including but not limited to, technical assistance that could be made available to Medicaid providers.
  • Provide data to inform the meaningful use objectives being developed by the Centers for Medicare & Medicaid for Stages 2 and 3 of the EHR Incentive Program.

The project conducted seventeen focus groups with 68 Medicaid EHR Incentive Program-eligible professionals. Of the 17 groups, 12 were users of EHRs and five were non-users. Participants were asked about their own experiences with EHRs, including barriers and facilitators of their use. Participants were noted to have differing levels of knowledge about the Medicaid MU program.

The project team found that in general the barriers to adoption and meaningful use of EHRs were similar to other groups, and not unique to those providers serving a primarily Medicaid-insured population. Providers noted that there were few differences between their Medicaid versus private-insured populations, and pointed out that many individuals come on and off Medicaid depending on their employment status. Barriers that were identified were specific to the types of providers who are eligible for the Medicaid MU program but not the Medicare MU program – specifically dentists and pediatricians.

The project team made four recommendations as a result of their research that may be found in their final report Barriers to Meaningful Use in Medicaid: 1) promote a more proactive approach by Medicaid agencies to assist Medicaid providers in achieving MU; 2) provide more targeted, coordinated technical assistance tools, methods, and processes for Stage 1 MU for Medicaid providers; 3) promote planning for the Stage 2 Meaningful Use requirements; and 4) create a short- and long-term research agenda that addresses many of the sociocultural, technical, and training/technical assistance needs of Medicaid providers and other providers who were identified in this study.

Barriers to Meaningful Use in Medicaid - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    Medicaid/CHIP Technical Assistance Contract
  • Contract Number: 
    290-07-10079-2
  • Project Period: 
    June 2010 – June 2012
  • AHRQ Funding Amount: 
    $396,722
  • PDF Version: 
    (PDF, 243.48 KB)

Summary: The Health Information Technology for Economic and Clinical Health Act (HITECH) offers financial incentives for Medicaid providers to adopt and meaningfully use certified electronic health records (EHRs). To ensure that eligible professionals, including physicians, dentists, certified nurse-midwives, nurse practitioners, and some physician assistants, are able to qualify for and access these incentives, this 2-year project studied the barriers that Medicaid providers encounter when they try to achieve ‘meaningful use’ under the Centers for Medicare and Medicaid Services’ (CMS’) Medicaid EHR Incentive Program.

The project analyzed barriers that Medicaid providers face in adopting and using EHRs. The final report provides recommendations to help Medicaid providers take advantage of incentive payments, achieve meaningful use (MU), and ultimately use health information technology (IT) to improve health care for Medicaid beneficiaries. Data for this project were collected from rural and urban physicians, pediatricians, dentists, and mid-level providers using a structured interview guide for both in-person and virtual focus group meetings. A technical expert panel comprised of key stakeholders, including staff from the Office of the National Coordinator for Health IT, CMS, and the Health Resources and Services Administration, provided guidance on the study design, data collection instruments, data analysis, and final report recommendations. The final report recommendations were developed to inform current and future policy related to MU of EHRs among Medicaid providers.

Project Objectives: 

  • Identify the barriers to eligibility for the incentive payments; barriers to adoption, implementation or upgrading of EHR systems; and barriers to achieving meaningful use. (Achieved) 
  • Develop actionable recommendations to overcome barriers identified above, including but not limited to technical assistance that could be made available to Medicaid providers. (Achieved) 
  • Provide data to inform the meaningful use objectives being developed by CMS for Stages 2 and 3 of the EHR Incentive Program. (Achieved) 

2012 Activities: Activities focused on conducting 17 focus groups, analyzing the findings, and developing the final recommendations. The 17 focus groups included 12 groups of EHR adopters and five groups of non-adopters. Study participants included a mix of adult medicine physicians, pediatricians, nurse practitioners, physician assistants, certified nurse midwives, and dentists who were asked about their experiences with specific barriers and enabling factors to adopting and using EHRs.

Impact and Findings: Participants reported varying awareness of the Medicaid EHR Incentive Program. Key findings focused on awareness of the program and its influence on adoption and MU of EHRs. With regard to adopting EHRs, findings focused on the process of selecting an EHR that met the provider’s needs. The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals have reported in other studies. However, all findings were useful in generating a set of recommendations for promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. Barriers to implementing EHRs focused mostly on the ways in which an EHR did not function well in the course of providing clinical care and required frequent workarounds and additional time. Many participants reported that they were not currently meeting one or more of the Stage 1 MU objectives, which is likely to impede their ability to achieve future stages of MU.

The final report included four overarching recommendations for Federal and State agencies that want to minimize barriers to adoption and use of EHRs by Medicaid providers: 1) promote opportunities for a more proactive approach by Medicaid agencies to facilitate the achievement of MU among Medicaid providers; 2) recommend more targeted, coordinated technical assistance for Stage 1 MU for Medicaid providers; 3) promote planning for the Stage 2 MU requirements; and 4) create a short- and long-term research agenda that addresses sociocultural, technical, and training and technical assistance needs of Medicaid providers.

The findings from this study provide significant insight into the practice environments of both urban and rural Medicaid providers who have either adopted EHR technology or are considering doing so under the Medicaid EHR Incentive Program. Focus group participants provided detailed descriptions of challenges and successes in their attempts to integrate technology into their workflow and practice settings. While this study focused on Medicaid providers, many of the findings may be useful for any provider considering selecting and implementing an EHR in his/her practice.

Target Population: Adults, Medicaid, Pediatric*, Safety Net

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

*This target population is one of AHRQ’s priority populations.

Barriers to Meaningful Use in Medicaid - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-07-10079-2
  • Project Period: 
    June 2010 - June 2012
  • AHRQ Funding Amount: 
    $396,722
  • PDF Version: 
    (PDF, 184.29 KB)

Summary: The Health Information Technology for Economic and Clinical Health Act (HITECH) offers financial incentives for Medicaid providers to adopt and meaningfully use certified electronic health record (EHR) technologies. To ensure that eligible professionals, including physicians, dentists, certified nurse-midwives, nurse practitioners, and some physician assistants, are able to qualify for and access these incentives, this 2-year project is studying the barriers that Medicaid providers encounter when they try to achieve 'meaningful use' as defined in the Centers for Medicare and Medicaid Services' (CMS') EHR Incentive Program. The project provides actionable recommendations to help Medicaid providers take advantage of incentive payments, achieve meaningful use, and ultimately use health information technology (IT) to improve health care for the Medicaid population.

Data for this project are being collected from both in-person and virtual focus groups with physicians, pediatricians, dentists, and mid-level providers. A technical expert panel (TEP) comprised of key stakeholders, including staff from the Office of the National Coordinator (ONC) for Health IT, CMS, and the Health Resources and Services Administration, has provided guidance on the research plan, data collection design, and implementation plan. The panel will also provide guidance on data analysis and final report recommendations.

These activities will help Federal stakeholders understand the barriers to meaningful use among Medicaid providers and will help inform future Federal regulations.

Project Objectives:

  • Identify the barriers to eligibility for the incentive payments; barriers to adoption, implementation, or upgrading of EHR systems; and barriers to achieving meaningful use. (Ongoing)
  • Develop actionable recommendations to overcome barriers identified above, including but not limited to technical assistance that could be made available to Medicaid providers. (Ongoing)
  • Provide data to inform the meaningful use objectives being developed by CMS for Stages 2 and 3 of the EHR Incentive Program. (Upcoming)

2011 Activities: In October, the study team received approval from the Office of Management and Budget to conduct the focus groups, which will be held in 2012. Subsequently, pilot testing of the focus group questionnaires was conducted among one in-person focus group, one virtual focus group, and two one-on-one interviews; one with a private family physician with no EHR and the other with a private practice pediatrician with no EHR. The team experienced challenges recruiting non-adopters of EHR to the pilot discussions, but among the pilot participants the discussions were found to be helpful to the project team. The remainder of the project timeline includes conducting a total of 17 focus groups (three in-person, 14 virtual), analyzing the findings, and developing a final report.

Preliminary Impact and Findings: There are no findings to report at this time.

Target Population: Adults, Medicaid, Pediatric*, Safety Net

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions, and the electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination


* This target population is one of AHRQ's priority populations.

Barriers to Meaningful Use in Medicaid - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-07-10079-2
  • Project Period: 
    June 2010 – June 2012
  • AHRQ Funding Amount: 
    $396,722
  • PDF Version: 
    (PDF, 313.68 KB)


Target Population: Adults, Medicaid, Pediatric*, Safety Net

Summary: The Health Information Technology for Economic and Clinical Health Act offers financial incentives for Medicaid providers to adopt and meaningfully use certified electronic health record (EHR) technologies. To ensure that eligible professionals, including physicians, dentists, certified nurse-midwifes, nurse practitioners, and some physician assistants, are able to qualify for and access these incentives, this 2-year project was initiated to study the barriers that Medicaid providers encounter when they try to achieve meaningful use as defined in the Centers for Medicare and Medicaid Services’ (CMS) EHR Incentive Program. The project is designed to develop actionable recommendations to help Medicaid providers take advantage of incentive payments, achieve meaningful use, and ultimately use health information technology (IT) to improve health care for the Medicaid population.

The data collection methods for this project include both in-person and virtual focus groups with physicians, pediatricians, dentists, and mid-level providers. A technical expert panel (TEP) comprised of key stakeholders, including staff from the Office of the National Coordinator for Health IT, CMS, and the Health Resources and Services Administration, will provide guidance on the research plan, data collection design and implementation, data analysis, and the final report recommendations.

These activities will help Federal stakeholders understand the barriers to meaningful use among Medicaid providers and will inform future Federal regulations, particularly in the development of meaningful use criteria for Stages 2 and 3. This project will yield actionable recommendations to increase effective EHR use by Medicaid providers to improve health care quality and will inform the development of recommendations for technical assistance to overcome identified barriers.

Project Objectives:
  • Identify the barriers to eligibility for the incentive payments; barriers to adoption, implementation, or upgrading of EHR systems; and barriers to achieving meaningful use. (Ongoing)
  • Develop actionable recommendations to overcome barriers identified above, including but not limited to, technical assistance that could be made available to Medicaid providers. (Upcoming)
  • Provide data to inform the meaningful use objectives being developed by CMS for Stages 2 and 3 of the EHR Incentive Program. (Upcoming)

2010 Activities: The key project activities included development of the work plan and research plan, development of the data collection instruments, preparations for clearance for data collection from the Office of Management and Budget, planning for pilot testing, and developing recruitment strategies for both the pilot test and main study. In addition, the TEP was convened in September 2010 to provide input into the research plan and draft data collection instruments. Pilot testing will be completed in January 2011 with data collection for the main study anticipated to begin in summer 2011.

Preliminary Impact and Findings: There are no findings to report at this time.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions, and the electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

*AHRQ Priority Population.

Barriers to meaningful use in Medicaid: analysis and recommendations.

Citation:
Kissam SM, Banger AK, Dimitropoulos LL, et al. Barriers to meaningful use in Medicaid: analysis and recommendations. (Prepared by RTI International, under Contract No. 290-07-10079-2.) AHRQ Publication No. 12-0062-EF. Rockville, MD: Agency for Healthcare Research and Quality. August 2012. (PDF, 682.31 KB)
Principal Investigator: 
Document Type: 
Research Method: 
Population: 
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