Associations between Florida counties’ COVID-19 case and death rates and meaningful use among Medicaid providers: Cross-sectional ecologic study

Abstract

Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated adoption of Electronic Health Records (EHRs) among Medicaid providers, only half achieved Meaningful Use. Furthermore, Meaningful Use’ impact on reporting and/or clinical outcomes remains unknown. To address this deficit, we assessed the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level cumulative COVID-19 death, case and case fatality rates (CFR), accounting for county-level demographics, socioeconomic and clinical markers, and healthcare environment. We found that cumulative incidence rates of COVID-19 deaths and CFRs were significantly different between the 5025 Medicaid providers not achieving Meaningful Use and the 3723 achieving Meaningful Use (mean 0.8334/1000 population; SD = 0.3489 vs. mean = 0.8216/1000; SD = 0.3227, respectively) (P = .01). CFRs were .01797 and .01781, respectively, P = .04. County-level characteristics independently associated with increased COVID-19 death rates and CFRs include greater concentrations of persons of African American or Black race, lower median household income, higher unemployment, and higher concentrations of those living in poverty and without health insurance (all P < .001). In accordance with other studies, social determinants of health were independently associated with clinical outcomes. Our findings also suggest that the association between Florida counties’ public health outcomes and Meaningful Use achievement may have had less to do with using EHRs for reporting of clinical outcomes and more to do with using EHRs for coordination of care—a key measure of quality. The Florida Medicaid Promoting Interoperability Program which incentivized Medicaid providers towards achieving Meaningful Use, has demonstrated success regarding both rates of adoption and clinical outcomes. Because the Program ends in 2021, we support programs such as HealthyPeople 2030 Health IT which address the remaining half of Florida Medicaid providers who have not yet achieved Meaningful Use. Author summary Our study investigates whether government support during 2012–2018 to increase technology among Medicaid providers to implement electronic health records is associated with reported COVID-19 death and case rates. We found that reported cumulative COVID-19 death rates were significantly greater in counties where more providers lacked the technology. Case rates were not associated with providers’ access to this technology. Counties with greater percentages of residents who are African American/Black, unemployed, living in poverty, underinsured and with histories of chronic lower respiratory disease, influenza or pneumonia were associated with worse clinical outcomes. Our findings also suggest that this technology may have been used primarily to coordinate patient care—a key quality indicator, rather than for reporting outcomes to public health agencies. Because program year 2021 marked the end of the Florida Promoting Interoperability Incentive Program, our findings provide baseline data to extend this support beyond 2021 in alignment with the Healthy People 2030 health information technology objectives. Increasing the proportion of office based Medicaid providers using advanced EHRs functions will help minimize an emerging “digital divide” between the quality of care provided to the nation’s most vulnerable patients who access care from Medicaid providers not having achieved meaningful use vs. those Medicaid providers using advanced EHR functions.