Article Figures & Data
Tables
Core Objectives (Practices Achieving Objective) Menu Objectives (Practices Achieving Objective) 1. Use computerized order entry for medication orders (n = 8) 1. Implement drug formulary checks (n = 8) 2. Implement drug–drug and drug–allergy checks (n = 8) 2. Incorporate clinical lab test results into certified EHR as structured data (n = 5) 3. Electronically generate and transmit permissible prescriptions (n = 8) 3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach (n = 8) 4. Record demographics (n = 8) 4. Send reminders for preventive/follow-up care to patients per patient preference (n = 5) 5. Maintain an up-to-date problem list of current and active diagnoses (n = 7) 5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) (n = 5) 6. Maintain active medication list (n = 8) 6. Use certified EHR to identify patient-specific education resources and provide to patient if appropriate (n = 6) 7. Maintain active medication allergy list (n = 8) 7. Perform medication reconciliation when relevant (n = 6) 8. Record and chart changes in vital signs (n = 8) 8. Provide summary care record for transitions in care or referrals (n = 5) 9. Record smoking status for patients ≥13 years old (n = 8) 9. Capability to submit electronic data to immunization registries and actual submission* (n = 6) 10. Implement one clinical decision support rule (n = 7) 10. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmissions* (n = 3) 11. Report ambulatory quality measures to CMS or the state (n = 7) 12. Provide patients with an electronic copy of their health information upon request (n = 8) 13. Provide clinical summaries of each office visit to patients (n = 8) 14. Capability to exchange key clinical information electronically among providers and patient-authorized entities (n = 6) 15. Protect electronic health information (privacy and security) (n = 7) Core and Menu objectives can be found at http://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-1.
↵* Menu objective 9 or 10 was required as a public health objective.
CMS, Centers for Medicare and Medicaid Services; EHR, electronic health record.
- Table 2. Critical Processes for Successfully Adopting an Electronic Health Record (EHR) and Implementing and Achieving Meaningful Use of EHRs
Recognize that deliberate, careful, and timely planning is required for choosing an EHR system and vendor and for achieving MU. Use your peer network to aid in decision making. Shadow users at similar practices that have adopted the candidate systems. Ask about customer support, upgrades, etc.
Invite top candidates to set up their system in your office for a few weeks' trial side by side. Dedicate time for the implementation team to “test drive” the systems.
Formulate realistic timetables and hold potential vendors to them.
Plan for a significant initial slowdown in patient throughput and possibly as the new standard for some practices over the long term.
Monitor reports to ensure uniform data collection to guide MU efforts.
Designate a team leader and build the right implementation team. Include representatives from all areas, such as billing, IT, clinical, and risk management.
Designating an empowered team leader is invaluable to help stay focused and achieve results.
Recognize that changes in the practice team can affect drive for MU.
Invite a trusted resource with experience in implementation, such as the REC, to help navigate the process.
Understand your workflow and how it will change with an EHR. Understand your current process before you decide on a specific EHR.
Optimize workflow processes. A poor process on paper will not become efficient just because it is electronic.
Change your workflow in the existing system before you implement the new electronic system.
Creating and generating reports are not easy but are extremely useful for monitoring quality improvement.
Devote resources to initial and ongoing training. Develop training tailored to your practice needs.
Do not confuse intensity of training with its utility, particularly with webinars.
Schedule short training sessions specific to the needs of the office because they are easier to manage in terms of scheduling and retaining information.
Request on-site trainings and, when possible, make arrangements for video capture for future use.
Develop and implement a continuous training program specific to the EHR.
Understand the resources needed for success. Recognize start-up and ongoing costs associated with the EHR.
Network to identify other users. This is helpful both in the initial decision-making stage and for ongoing mutual help, such as shared training.
Understand that EHR adoption may require changes in the skills and duties of clinical staff.
Secure legal counsel for contractual arrangements.
Increased need for general IT support and system specialists; have at least one “super-user” on staff.
IT, information technology; MU, meaningful use; REC, regional extension center.
