When the Health IT Policy Committee was drafting standards for Stage 2 of meaningful use, many people noted that it would have been helpful to wait until there was more input about the challenges people had meeting Stage 1. (Of course, as committee leaders such as Paul Tang, M.D., pointed out, the schedule of the HITECH Act incentives dictated when Stage 2 work needed to begin.) Anyway, we are starting to get some of that feedback from hospitals and physician groups about what was most challenging about attesting to Stage 1, and the issues that crop up, particularly in physicians’ offices, were not necessarily obvious before the effort was made.

I saw a great presentation Nov. 27 by Denise Scott, director of quality & informatics at CDPA, a multi-specialty practice association in western Massachusetts, whose physicians adopted a common EHR and successfully attested to Meaningful Use in 2012. 
 Sponsored by consulting firm Physicians EHR, her talk focused on “taming the six unruly meaningful use measures.”

Which six measures does she describe as the most unruly?
1.    Recording vital signs
2.    Smoking status
3.    E-prescribing
4.    CPOE
5.    Clinical summaries
6.    Clinical quality measures

Scott’s presentation focused on how workflow redesign and meaningful use must be tied together.

“First, you have to really understand the measures,” she said. “You have to understand the technology you have adopted, and how you are going to meet the measures.”

The key challenges, she added, involve vendor product nuances, workflows that needed to be redesigned, and staff roles that needed to be redefined.

For instance, with recording vital signs, there may be different staffers recording height, weight and blood pressure, and often multiple places in an EHR where you can enter the data, yet only one place where it will feed a meaningful use dashboard. “You have to better define staff roles and enforce consistent documentation across the practice,” Scott said.

For e-prescribing, the calculation of 40 percent of permissible prescriptions has been challenging to many practices, she said. They have to remember to discount narcotics and durable medical equipment. Again, it requires clearer role delineations. “I have seen front-desk people sending off the e-prescriptions,” she said. “You must assign appropriate access privileges.” Practices must also focus on limiting non-electronic options for refills and educate patients about the benefits of e-prescribing.

With clinical summaries, there is often staff role confusion about who is supposed to print the summary and hand it to the patient. Scott says she has found limited understanding of the purpose and value of the summary. They see it as just additional work for the provider, done just to get the incentive funding and for no other purpose. Again, she recommends better-defined workflows to make it clear who offers the summary and reviews it with patients. “Educating the staff and taking a team approach is important, so that everyone understands the importance of this.”

Looking ahead to Stage 2, what does Scott see as the biggest potential challenge for physician practices? “I think it is going to be engaging patients and families,” she said. ‘That requires a huge cultural shift. Getting patients registered for secure messaging is not going to happen by the staff suggesting it,” she said. “The physician is going to have to actively engage them about why it is important to use a portal.”