Table 3. Major Thematic Constructs with Examples of Barriers, Successes, and Resources That Support Practices in Their Journey to Meaningful Use Data
BarriersSuccessesSupport Resources
Getting StartedProvider and staff resistance to changeStaff and provider buy-inLearning collaborative
Lack of personal connection to meaningful use changesStaff and provider turnoverOn-site advising, education, and training
Technical insufficiency of EHR*Alignment of practice vision with vision of meaningful useNetwork of local/regional peers
Re-engineeringEHR: cost, technical limitations, upgrades, new installations (especially among “certified” EHRs)Technical support and troubleshootingQI advisors
EHR vendor supportImproved office processes and efficiencyHealth IT REC
Data quality and accuracyImproved consistency of EHR useTraining
Insufficient office processesAccurate data and reportsLearning collaboratives
Inconsistent use of EHRQI tools and processes (eg, PDSAs, process maps, regular meetings, communication)Peers
Time-consuming and tediousCulture changeLocal technical support and expertise
Staff role changesStaff engagement
Stronger sense of community among practices
AttestationInflexible meaningful use criteriaSuccessful attestation of stage 1 meaningful useQI advisors
Health IT REC
Technical support
Using Data MeaningfullyAvailability of time and resourcesRegistriesLocal technical support and expertise
EHR upgrades, insufficiency (especially for stages 2 and 3)Population managementLearning collaboratives
EHR vendor supportRoutine use of dataQI advisors (resources, connections, accountability, research, cross-practice sharing)
FatiguePatient portalsNetwork of peers/collaborators
Continued staff or provider resistanceMedication reconciliation
Patient activation and participationNew patient services
Lack of shared vision or understandingPatient 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.