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Core objectives* Improve quality, safety, efficiency Use computerized provider order entry for medication orders Implement drug interaction checks Maintain up-to-date problem list Generate and transmit prescriptions electronically Maintain active medication list Maintain active medication allergy list Record demographics Record vital signs Record smoking status Report ambulatory clinical quality measures Implement one clinical decision support rule Engage patients and families Provide patients with electronic copy of health information Provide clinical summaries for patients Improve care coordination Capability to exchange key clinical information Ensure privacy and security for personal health information Protect electronic health information Menu objectives† Improve quality, safety, efficiency Implement drug formulary checks Incorporate clinical lab test results as structured data in EHR Generate patient list by specific condition Send reminders to patients Engage patients and families Provide patients with timely electronic access Identify patient-specific education resources Improve care coordination Perform medication reconciliation for care transitions Provide summary care record for care transitions and referrals Public health Capability to submit data to immunization registries or information systems Capability to submit electronic syndromic surveillance data to public health agencies Data source Description Participants Practice narratives Open-ended responses to structured questions; completed by practice personnel (staff or providers) 51 practices (39 family medicine, 7 general internal medicine, 5 general pediatrics) QI advisors focus group discussion Semistructured focus group discussion; facilitated by the evaluation team; in person 1 group discussion (all 5 QI advisors plus 1 technical analyst) REC focus group discussion Semistructured focus group discussion; facilitated by the evaluation team; by teleconference 1 group discussion with REC staff/leadership (6 staff from the REC, including executive staff) Provider and staff interviews Semistructured individual or paired interviews; facilitated by the evaluation team; by teleconference or in person 13 interviews (9 family medicine, 2 general internal medicine, 2 general pediatrics; included 7 providers, 9 staff overall; 3 interviews included both) REC, regional extension center; QI, quality improvement.
- Table 3. Major Thematic Constructs with Examples of Barriers, Successes, and Resources That Support Practices in Their Journey to Meaningful Use Data
Barriers Successes Support Resources Getting Started Provider and staff resistance to change Staff and provider buy-in Learning collaborative Lack of personal connection to meaningful use changes Staff and provider turnover On-site advising, education, and training Technical insufficiency of EHR* Alignment of practice vision with vision of meaningful use Network of local/regional peers Re-engineering EHR: cost, technical limitations, upgrades, new installations (especially among “certified” EHRs) Technical support and troubleshooting QI advisors EHR vendor support Improved office processes and efficiency Health IT REC Data quality and accuracy Improved consistency of EHR use Training Insufficient office processes Accurate data and reports Learning collaboratives Inconsistent use of EHR QI tools and processes (eg, PDSAs, process maps, regular meetings, communication) Peers Time-consuming and tedious Culture change Local technical support and expertise Staff role changes Staff engagement Stronger sense of community among practices Attestation Inflexible meaningful use criteria Successful attestation of stage 1 meaningful use QI advisors Health IT REC Technical support Using Data Meaningfully Availability of time and resources Registries Local technical support and expertise EHR upgrades, insufficiency (especially for stages 2 and 3) Population management Learning collaboratives EHR vendor support Routine use of data QI advisors (resources, connections, accountability, research, cross-practice sharing) Fatigue Patient portals Network of peers/collaborators Continued staff or provider resistance Medication reconciliation Patient activation and participation New patient services Lack of shared vision or understanding Patient feedback Automated patient follow-up EHR, electronic health record; IT, information technology; PDSA, plan-do-study-act learning cycle; QI, quality improvement; REC, regional extension center.
1. Realize that your practice is not just “checking boxes” for meaningful use attestation; you are really changing the way you provide health care. 2. Find and use any knowledgeable sources of local support. Ask a lot of questions and know that you're not the only one out there with questions. Talk with other practices. Learn from others, but use what fits with your style and your practice. 3. Set realistic expectations regarding this work and your progress. Work on small chunks one step at a time. 4. Keep focused on the bigger picture of improving patient care and how everyone's work contributes to that bigger picture. 5. Get your baseline data in order before thinking about how you're going to make improvements in the data. 6. Make the best attempt to choose an EHR that can address what you need it to do. Then take the time to fully understand the capabilities of your EHR. 7. Get your staff involved and engaged in the process. Find the incentive that motivates your providers and staff. Meet regularly with staff and providers to get input and feedback on changes and promote regular communication. 8. Help your physicians and staff to become better users of their EHR. Provide them with training. 9. Understand the measures and what's being asked of you. Get consensus among your providers on which measures are important to focus on and then stick with them. Then take time to understand your data and display your data and reports for all providers and staff in your practice to see. 10. Understand the costs associated with using EHR data effectively. EHR, electronic health record.
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