Physician Practices Still Struggling with Meaningful Use


With the Stage 2 rules of meaningful use looming, physicians are still struggling with the implementation process for Stage 1.

The Stage 1 rules of CMS' EHR Incentive Program have largely been about getting certified systems implemented and physician practices learning to use them effectively.

According to the HHS' Office of the National Coordinator (ONC), over 335,000 professionals and 4,400 hospitals have received incentive payments for adopting certified EHRs or demonstrating meaningful use. Furthermore:

• Nearly 80 percent of office-based physicians used some type of EHR, an increase of 60 percentage points since 2001 and nearly double the percent in 2008 (42 percent), one year before HITECH became law.• About half of office-based physicians surveyed said they use a system that qualifies as a "basic system," up from just 11 percent in 2006.• Almost 70 percent of office-based physicians noted their intent to participate in the EHR incentive program.

Meeting the reporting conditions has been an early challenge for practices of all sizes. Since attesters must report directly from their EHRs, systems have had to be certified and capable of calculating and reporting quality measures.

Quite possibly the two most difficult Stage 1 requirements of meaningful use for physicians are both centered around providing patients with copies of their medical information. For instance, providing electronic copies of information to 50 percent of patients who request it.

"Originally you had to collect about five pieces of data and now it’s about 20 pieces of data," said Robin Raiford, senior director for The Advisory Board's IT Strategy Council. "This way you have to push that data to 50 percent of all of your encounters. But it sets them up to have this active patient engagement once they get to Stage 2."

Even with effective training and preparation, the transition of care can also be a stumbling block said Mary Griskewicz, senior director of health information systems for the Healthcare Information and Management Systems Society (HIMSS).

"Once they’ve committed, one of the areas that they tend to have problems with is overall care coordination and transitions of care and some of that is because a lot of those folks that they want to exchange information with are not on the same system, and the interoperability is still not there," said Griskewicz.

Some practices believe the smarter decision is to implement EHR systems that help achieve long-term goals rather than the specific measures of Stage 1.

That was the strategy employed by Massachusetts-based Reliant Medical Group (formerly Fallon Clinic), a group practice with 30 different specialties at 23 facilities and recipient of the HIMSS Davies Ambulatory Award in 2011. The award recognizes achievement in the implementation and value from health IT, specifically EHRs.

Reliant began their journey to an EHR as early as 2001, which paved the way to meaningful use compliance in 2011.

"The meaningful use dollars cover about a third of the cost [of EHR], but I could not excel the way that I do right now as a highly competent physician if it wasn’t for the fact that we have EHRs," said Lawrence Garber, medical director for informatics with Reliant Medical Group. "Meaningful use is great when you get the money given to you, but you should be implementing EHRs because it’s really the best thing for your patients and that’s whey we should be doing it."

Rodney J. Mooreis a freelance journalist and healthcare content provider based in Nashville, Tenn. He can be reached at

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