The Impact of Market Factors on Meaningful Use of Electronic Health Records among Primary Care Providers: Evidence from Florida Using Resource Dependence Theory and Information Uncertainty Perspective

Background: Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country. Objective: Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida - EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology. Research Design: Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers. Main Outcome: MU achievement after first-year incentives. Independent Variables: The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita. Analytical Approach: All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1). Results: Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU (P<0.001). Significant differences in MU achievements were obtained when we compared the "high" terciles with the "low" terciles for poverty rates (P=0.002), health maintenance organization penetration rates (P=0.02), and number of PCPs per capita (P=0.01). These relationships were negative. Conclusions: Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.