Pediatricians are adopting electronic health records, but getting access to financial incentives from the meaningful use incentive program remains a challenge.

“Currently, pediatricians seeking [meaningful use] payments for using EHRs … must exceed a threshold of 20% of encounters with Medicaid-insured children,” wrote Dorothy Miller, an attorney at the PolicyLab at Children’s Hospital of Philadelphia and the University of Pennsylvania and her colleagues.

“In contrast, providers who treat adults can opt to participate through either the Medicare EHR incentive program, which has no patient threshold, or the Medicaid incentive program, which has a 30% threshold,” they said in a perspective column (Pediatrics 2014 Dec. 29 [doi:10.1542/peds.2014-2438]).

Ms. Miller and her colleagues noted that the 20% threshold can be difficult to achieve. Payments from Medicaid are low and ofter come slowly, leading few pediatricians to accept Medicaid payments. Also, in states where the Children’s Health Insurance Program operates independent of a state Medicaid program, encounters with those patients do not count toward the meaningful use threshold. Reporting requirements for Medicaid also present challenges, as there are “56 different systems through which pediatricians report their meaningful use participation to their respective state or territory, a much less consistent approach than the single, central federal repository under Medicare,” they added.

Despite the challenges, pediatric use of electronic health records is on the rise. In 2012, 79% of pediatricians used an EHR, up from 58% in 2009.

The data from 2012 are based on a survey of 1,621 nonretired, randomly selected U.S.-based members of the American Academy of Pediatrics , which also conducted the survey. The AAP conducted a similar survey in 2009. Each member received a self-administered questionnaire between July and December 2012 (Pediatrics [ doi:10.1542/peds.2014-1115 ]).

Approximately half of all pediatricians (53%) said their main practice EHRs met the functional criteria for Stage 1 of meaningful use, though only 45% said their main practice applied for meaningful use incentives, Dr. Christoph Lehmann of the Vanderbilt University department of pediatrics and biomedical informatics, Nashville, Tenn., and colleagues reported.

“One-fifth of the 53% reporting to meet meaningful use Stage 1 in 2012 do not intend to apply for meaningful use incentives in later stages,” they noted. “Because meaningful use is ‘front-loaded’ with the largest incentives in the first year, pediatricians may be electing not to implement later meaningful use criteria, thus hampering the intended goal of increased adoption of functional EHRs.”

Although 79% reported using an EHR, only 31% reported using an EHR with basic functionality and 14% with full functionality. Eight percent reported using an EHR with optimal functionality including pediatric features, a statistic Dr. Lehmann and colleagues described as “disappointingly low.”

Half of the pediatricians surveyed agreed that EHRs are “necessary to provide quality patient care,” while 32% disagreed with that statement.


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