title: Meaningful use: Floor or ceiling?
abstract: BACKGROUND
  In 2011, federal incentive payments for meaningful use of electronic health records (EHRs) began. This study evaluates the impact of the program on hospitals and EHR vendors, identifying how it affects EHR planning and development. Specifically, it assesses whether vendors and Chief Information Officers (CIOs) are viewing the meaningful use requirements as a floor - the minimally acceptable level of implementation, upon which development continues - or as a ceiling - the upper-bound on EHR development and implementation.
  
  
  METHODS
  The study combines interviews with EHR vendors and hospital CIOs with EHR adoption data from American Hospital Association surveys. Results from interviews with 17 hospital and system CIOs (representing 144 individual acute-care hospitals) and 8 EHR development executives (representing two-thirds of installations) are detailed. Furthermore, it compares adoption of two key EHR functions, BCMA and CPOE, which are treated differently under stage 1 of the incentive program.
  
  
  RESULTS
  Three key findings emerge from the study. First, meaningful use requirements can serve as either a floor or a ceiling, depending on the abilities of institutions implementing EHRs. Second, the increasing focus on achieving meaningful use across both hospitals and vendors risks missing the forest of health care system change through the trees of meeting discrete requirements. Third, while the meaningful use incentive program has accelerated the development and implementation of some key functions, it has also slowed development of others.
  
  
  CONCLUSIONS
  Policy makers should craft subsequent stages of the incentive program to ensure smaller facilities and additional features necessary for health care system change are not left behind.
authors.affiliation: Ph.D. Program in Health Policy, Harvard University, Cambridge, MA 02138, United States. Electronic address: mbotta@mail.harvard.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Botta
authors.affiliation: Department of Economics, Harvard University, Cambridge, MA 02138, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: Cutler
keywords: Health IT; Hospitals; Meaningful use; Qualitative; Vendors