Date of Award

Winter 12-5-2016

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Terrence F Cahill, Ed.D

Committee Member

Ning Zhang, MD

Committee Member

Fortunato Battaglia, MD

Committee Member

Kenneth Ong, MD


Meaningful Use, Electronic Health Record, HITECH Act, Value Based Purchasing, Quality Outcomes, Interoperability


Background and Purpose of the Study: The U.S. healthcare system at $3 trillion, is the sixth largest economy in the world. The federal government is the largest purchaser of healthcare in the country. In the past decade it has been on a quest to refocus its purchasing from volume to value. While spending nearly double per capita than every other industrialized nation, U.S. healthcare outcomes are consistently in the lowest quartile for every major indicator from life expectancy to ambulatory sensitive conditions. The Crossing the Quality Chasm Report (IOM) focused a lens on the dearth of electronic health record (EHR) systems nationally. Resultant legislation, the HITECH Act, funded a $50 billion investment to close this gap along with promulgation of standards known as Meaningful Use (MU) to achieve interoperability. This investment and related MU protocols for implementation warrant a careful examination to establish if the intended improved outcomes have been achieved.

Methods: The study is a cross-sectional, retrospective design; it employs two cohorts, Meaningful Use (MU) vs Non-MU hospitals. Publicly reported data on clinical outcomes, cost and safety from 4221 or 95% of the nation’s hospitals were included in the analysis to identify if there is a difference in outcomes between the hospital cohorts.

Results: 2315 of the 4221 or 55% hospitals who were included in the study met MU standards by 2013. The profile of an MU hospital was a non-teaching (70%), geographically southern (40%), not-for-profit hospital (61%). Non-Mu hospital had a similar profile, 78% non-teaching, 35% Southern and 60% not-for-profit. Those hospitals who met MU had statistically lower mortality (p

Conclusion: The HITECH Act that committed over $50 billion in subsidy incentive funds has dramatically increased EHR adoption nationally from 8% in 2009 to over 50% by 2013. The results from this suggest hospitals that had implemented EHRs’ that meet MU standards demonstrate mortality and cost outcomes that result in statistically significant cost and clinical care benefit.