Sorting out EHR adoption and assimilation in the Meaningful Use incentive program in Hawaii

Both widespread adoption and meaningful assimilation are needed to achieve the full benefits of EHRs. In the U.S. the HITECH Act and its Meaningful Use (MU) program have stimulated EHR adoption to historically high levels. Questions remain about program efficacy and possible unintended consequences. In this paper, we report our analysis of Meaningful Use attestation data for the period 2011-2014 in the State of Hawai’i. Findings indicate that the MU program primarily stimulated deeper assimilation of EHRs among existing adopters in 2011, mostly in large practice groups. In subsequent years, EHR adoption and assimilation, evidenced by MU attestation, increased then peaked among small, independent practices. In the final study year, attestation rates dropped for small practices, although only one third of eligible providers have attested, while attestation among larger practices remained steady as this group shifted to the next MU stage. Findings suggest small practices, particularly primary care and rural practices, continue to face high barriers to meaningful EHR adoption and assimilation. Findings suggest better targeted policies and incentives may be needed to keep this promising program on track.