title: Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system.
abstract: BACKGROUND
  Meaningful Use (MU) provides financial incentives for electronic health record (EHR) implementation. EHR implementation holds promise for improving healthcare delivery, but also requires substantial changes for providers and staff. Establishing readiness for these changes may be important for realizing potential EHR benefits. Our study assesses whether provider/staff perceptions about the appropriateness of MU and their departments' ability to support MU-related changes are associated with their reported readiness for MU-related changes.
  
  
  METHODS
  We surveyed providers and staff representing 47 ambulatory practices within an integrated delivery system. We assessed whether respondent's role and practice-setting type (primary versus specialty care) were associated with reported readiness for MU (i.e., willingness to change practice behavior and ability to document actions for MU) and hypothesized predictors of readiness (i.e., perceived appropriateness of MU and department support for MU). We then assessed associations between reported readiness and the hypothesized predictors of readiness.
  
  
  RESULTS
  In total, 400 providers/staff responded (response rate approximately 25%). Individuals working in specialty settings were more likely to report that MU will divert attention from other patient-care priorities (12.6% vs. 4.4%, p = 0.019), as compared to those in primary-care settings. As compared to advanced-practice providers and nursing staff, physicians were less likely to have strong confidence in their department's ability to solve MU implementation problems (28.4% vs. 47.1% vs. 42.6%, p = 0.023) and to report strong willingness to change their work practices for MU (57.9% vs. 83.3% vs. 82.0%, p < 0.001). Finally, provider/staff perceptions about whether MU aligns with departmental goals (OR = 3.99, 95% confidence interval (CI) = 2.13 to 7.48); MU will divert attention from other patient-care priorities (OR = 2.26, 95% CI = 1.26 to 4.06); their department will support MU-related change efforts (OR = 3.99, 95% CI = 2.13 to 7.48); and their department will be able to solve MU implementation problems (OR = 2.26, 95% CI = 1.26 to 4.06) were associated with their willingness to change practice behavior for MU.
  
  
  CONCLUSIONS
  Organizational leaders should gauge provider/staff perceptions about appropriateness and management support of MU-related change, as these perceptions might be related to subsequent implementation.
authors.affiliation: Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. chris_shea@unc.edu.|Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. chris_shea@unc.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Shea
authors.affiliation: Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. reiter@email.unc.edu.|Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. reiter@email.unc.edu.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Reiter
authors.affiliation: School of Medicine and Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. mark_weaver@med.unc.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: CareFirst BlueCross BlueShield, Baltimore, MD, USA. mmcintyr@gmail.com.
authors.forename: Molly
authors.initials: M
authors.lastname: McIntyre
authors.affiliation: Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. mose@email.unc.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Mose
authors.affiliation: UNC Faculty Physicians, Department of Practice Quality and Innovation, UNC Health Care, Chapel Hill, NC, USA. jonathan_thornhill@unchealthcare.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Thornhill
authors.affiliation: UNC Faculty Physicians, Department of Practice Quality and Innovation, UNC Health Care, Chapel Hill, NC, USA. robb_malone@unchealthcare.org.
authors.forename: Robb
authors.initials: R
authors.lastname: Malone
authors.affiliation: Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. weiner@email.unc.edu.|Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. weiner@email.unc.edu.|Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA. weiner@email.unc.edu.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D001291:Attitude of Health Personnel; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D057286:Electronic Health Records / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D062527:Meaningful Use / Q000191:economics / Q000592:standards*; D009657:North Carolina; D009936:Organizational Innovation / Q000191:economics; D012052:Reimbursement, Incentive; D014481:United States