J Am Med Inform Assoc doi:10.1136/amiajnl-2012-001142
  • Research and applications

Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011

  1. Nir Menachemi5
  1. 1Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
  2. 2Rawls College of Business Administration, Texas Tech University, Lubbock, Texas, USA
  3. 3Department of Management, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
  4. 4Department of Global Health Systems and Development, Tulane University, New Orleans, Louisiana, USA
  5. 5Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Christopher A Harle, Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL,32610 USA; charle{at}
  • Received 31 May 2012
  • Accepted 2 September 2012
  • Published Online First 22 September 2012


Objective In an effort to understand better the federal electronic health record (EHR) incentive programme's challenges, this study compared hospitals that did and did not receive meaningful use (MU) payments in the programme's first year based on the challenges they anticipated a year before.

Materials and Methods This cross-sectional study used 2010 American Hospital Association survey data and 2011 Centers for Medicare and Medicaid Services data that identify hospitals receiving MU payments. Multivariate regression analysis assessed differences in 2010 anticipated challenges to MU for hospitals that were successful in earning 2011 MU payment compared to hospitals that intended to participate in the programme but were not yet successful.

Results The study sample consisted of 2475 hospitals, 313 of which received MU payments in 2011. Controlling for standard hospital characteristics, hospitals that reported the computerized provider order entry (CPOE) MU criterion as a primary challenge were 18% less likely to receive a 2011 MU payment compared to hospitals that reported other criteria as primary challenges.

Discussion CPOE was the main challenge among hospitals that failed to achieve MU in the first year of the programme. In order to maximize the incentive programme's effectiveness, policymakers, healthcare organizations, and EHR vendors may benefit from increased attention to hospitals’ challenges with CPOE.

Conclusion As the EHR incentive programme matures, policymakers and other stakeholders should consider strategies that maintain the critical elements of MU while adequately supporting hospitals that desire to become MU but are impeded by specific technological, cultural, and organizational adoption and use challenges.

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