The Impact of Market Factors on Meaningful Use of Electronic Health Records Among Primary Care Providers

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.