title: Factors associated with meaningful use incentives in children's hospitals.
abstract: OBJECTIVE
  Among children's hospitals, little is known about how barriers to electronic health record (EHR) adoption are related to meaningful use (MU) incentives. We investigated hospital success with MU incentive payments and determined associations with hospital-reported challenges and characteristics.
  
  
  METHODS
  A survey administered to 224 Children's Hospital Association hospitals assessed a variety of potential challenges to achieving meaningful EHR use (eg, lack of access to capital) and specific MU criteria that would be challenging to fulfill (eg, implement clinical decision support rules). These results were combined with data on hospitals that received MU payments up to March 2014 and information on hospital characteristics. Associations between anticipated challenges, children's hospital type, and receipt of MU incentives were evaluated in bivariate and multivariate analyses.
  
  
  RESULTS
  One hundred thirty-three children hospitals completed the survey (response rate 59.4%). Thirty-five percent of responding children's hospitals received MU incentive payments. The most frequently anticipated hospital challenges included the following: exchange clinical information with other providers outside your hospital system (49%), and generate numerator and denominator data for quality reporting directly from EHR (41%). Freestanding children's hospitals were more likely to indicate lack of relevance of MU criteria to pediatric care (odds ratio: 37.6 [95% confidence interval: 4.6-309.3]) and more likely to receive MU incentive payments (odds ratio: 26 [95% confidence interval: 5.2-130.6]).
  
  
  CONCLUSIONS
  As of 2014, a minority of children's hospitals have successfully received MU incentive payments. Freestanding children's hospitals are more likely to report MU is not relevant to pediatric care and to succeed with MU incentive payments.
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; teufelr@musc.edu.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Teufel
authors.affiliation: Department of Pediatrics, St Louis Children's Hospital, Washington University, St Louis, Missouri;
authors.forename: Feliciano B
authors.initials: FB
authors.lastname: Yu
authors.affiliation: Divisions of Infectious Diseases, General Pediatrics, and.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Nakamura
authors.affiliation: Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; and.
authors.forename: Marvin B
authors.initials: MB
authors.lastname: Harper
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D002648:Child; D003625:Data Collection; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D062527:Meaningful Use; D012052:Reimbursement, Incentive; D012189:Retrospective Studies