title: Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL 32610, USA. charle@phhp.ufl.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Harle
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Huerta
authors.forename: Eric W
authors.initials: EW
authors.lastname: Ford
authors.forename: Mark L
authors.initials: ML
authors.lastname: Diana
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000191:economics*; D005377:Financial Management, Hospital; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D062527:Meaningful Use / Q000191:economics*; D050316:Medical Order Entry Systems / Q000191:economics; D015999:Multivariate Analysis; D012052:Reimbursement, Incentive; D014481:United States