1. Barriers to Meaningful Use in Medicaid 2011 AHRQ Annual Conference September 19, 2011 Presented by: Heather Johnson-Skrivanek, AHRQ Linda Dimitropoulos, Chuck Thompson, Stephanie Kissam, Alison Banger, RTI International Funded by the Agency for Healthcare Research and Quality

2. Session Objectives Provide background and impetus for studying the barriers to meaningful use of EHRs among Medicaid providers Summarize prior research Lead an interactive discussion of barriers, and policy and technical assistance solutions Discuss next steps for the project

3. Motivation for Study of Barriers to Meaningful Use in Medicaid Differences in Medicare and Medicaid populations; EHR incentive programs

4. Medicaid Eligible Professionals (EPs) EPs, private practice: physicians, pediatricians, dentists, certified nurse-midwives, nurse practitioners Minimum 30% Medicaid patients (20% for pediatricians) EPs, Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs): all of the above, plus physician assistants who lead those centers Minimum 30% Medicaid patients or “needy individuals” (includes CHIP) (20% for pediatricians)

5. Influences on Medicaid providers’ ability to demonstrate meaningful use of EHRs

6. Prior research What was EHR adoption rate among Medicaid providers prior to CMS EHR Incentive Program? First national survey of EHR use in Community Health Centers (CHCs): 26% reported some EHR capacity 13% have an EHR with a minimum set of functionalities (Shields et al., 2007) Survey of pediatricians: 21% had an EHR (Kemper et al., 2006) No prior definition of a “Medicaid provider”: scant research available on professionals in private practice

7. Prior research What is known about facilitators and barriers of EHR use among Medicaid providers? Facilitators for CHCs Internal IT support (Bramble et al., 2010) Participation in a Health Center Controlled Network (Egleson et al., 2010) For general providers, larger-sized practices more likely to adopt and use EHRs (Simon et al., 2008; Hing and Burt, 2009; Kemper et al., 2006)

8. Hypothesized Barriers To eligibility: Unsure of Medicaid patient volumes To adoption, implementation, or upgrade Lack of capital (Shields et al., 2007; Kemper et al., 2006) No availability of EHRs for Medicaid populations / dentists Few or no technical assistance resources

9. Hypothesized Barriers To achieving meaningful use: Difficulty in achieving Meaningful Use criteria themselves, such as clinical quality measures (CQMs) or core EHR functions Lack of IT support at practice Criteria (e.g., some CQMs) seen as not appropriate to Medicaid providers such as pediatricians, dentists, and nurse mid- wives

10. Small Group Discussion: Barriers to Meaningful Use What other barriers might exist for Medicaid providers attempting to achieve Meaningful Use? Please add any additional barriers to the notes sheet for your group.

11. Small Group Discussion: Policy Solutions and Technical Assistance Discuss potential solutions for each identified barrier. Solutions may be: Policy solutions (regulatory) Technical assistance from Federal/State government? Actions by other stakeholders? Other? Add solutions to the notes sheet

12. Next Steps for AHRQ / RTI Conduct focus groups in California, Louisiana, New York, and Tennessee Conduct virtual focus groups Analyze findings Report to inform: Outreach and assistance to Medicaid providers Future Meaningful Use regulations

13. References Bramble JD, Galt KA, Siracuse MV, Abbott AA, Drincic A, Paschal KA, Fuji KT. The relationship between physician practice characteristics and physician adoption of electronic health records. Health Care Manage Rev. 2010 Jan-Mar; 35(1):55-64. The relationship between physician practice characteristics and physician adoption of electronic health records. DesRoches, CM et al (2008) Electronic health records in ambulatory care — a national survey of physicians,” NEJM, 359:1; Egleson N, Kang JH, Collymore D, Esmond W, Gonzalez L, Pong P, Sherman L. A health center controlled network's experience in ambulatory care EHR implementation. J Healthc Inf Manag. 2010 Spring; 24(2):28-33 Hing E, Burt CW. Are there patient disparities when electronic health records are adopted? J Health Care Poor Underserved. 2009 May; 20(2):473-88. Kemper AR, Uren RL, Clark SJ. Adoption of Electronic Health Records in Primary Care Pediatric Practices. Pediatrics. 2006 July; 118(1):e20-e24. Shields AE, Shin P, Leu MG, Levy DE, Betancourt RM, Hawkins D, Proser M. Adoption of health information technology in community health centers: results of a national survey. Health Aff (Millwood). 2007 Sep-Oct; 26(5):1373-83. Simon, S.R., et al., Electronic health records: which practices have them, and how are clinicians using them? J Eval Clin Pract, 2008. 14(1): p. 43-7.