title: Effect of a state-based incentive programme on the use of electronic health records.
abstract: OBJECTIVE
  In 2004, New York passed the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) Capital Grants Program, which was the largest state-based investment in health information technology adoption in the United States. We sought to evaluate the effects of this programme on electronic health records (EHR) usage.
  
  
  METHODS
  We undertook a case-control study of health care providers who had signed up with a regional extension centre, some of whom had also received HEAL funding through programmes intended to support EHR adoption. The outcome of interest was achievement of Medicare or Medicaid Meaningful Use and the primary exposure was any link to HEAL NY funding. The association between Meaningful Use status and independent variables was measured using logistic regression models.
  
  
  RESULTS
  Meaningful Users were more likely to have had a history of HEAL NY funding (OR=1.83; 95% CI=1.59, 2.09). Also, achievement of Meaningful Use was associated with having an EHR before 2011 (OR=1.64; 95% CI=146, 1.83). Among those with EHRs prior to 2011, the odds of achieving Meaningful Use were statistically higher if coupled with HEAL NY funding (OR=3.12; 95% CI=2.50, 3.90).
  
  
  CONCLUSIONS
  Achieving Meaningful Use was associated with a history of HEAL NY funding. However, it was the combination of HEAL NY funding and historic usage of EHRs that was associated with the largest increase in the odds that the provider was a Meaningful User. These findings indicate that state-based incentive programmes can support the effective usage of health information technologies.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.forename: Erika
authors.initials: E
authors.lastname: Abramson
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Ancker
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data*; D006123:Group Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D062527:Meaningful Use / Q000706:statistics & numerical data*; D008484:Medicaid; D006278:Medicare; D008511:Medicine / Q000706:statistics & numerical data; D009042:Motivation; D009518:New York; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012737:Sex Factors; D013219:State Government; D014481:United States
keywords: doctors; electronic health records; incentives; meaningful use; programme evaluation; public policy