| 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.