EHR meaningful use: Do your research now


There's lot to think about when it comes to adopting an electronic health record system.

There's lot to think about when it comes to adopting an electronic health record (EHR) system. Certainly, urologists are concerned about the disruption of such a major system change in the practice. Their managers are concerned about the execution and process changes required, and everyone's heard a horror story or two about "the conversion gone bad," resulting in the plummeting of both customer service and physician productivity with enormous financial consequences.

No wonder many urologists are asking, "Do I really need to do this now?" The answer is no, not immediately, but it is inevitable within a few short years. Now is the time for urology practices to start planning-especially considering the government mandate that came with the passage of the American Recovery and Reinvestment Act, which has changed the playing field forever for EHR systems. Stimulus funds are available that promise as much as $44,000 per physician to implement an EHR system before the end of 2012-not all that far away.

Proving 'meaningful use'

Meaningful use is still in the process of being clearly defined by the federal government. Specific requirements are outlined in the proposed rule published in the Jan. 13, 2010 Federal Register. Some of these criteria are likely to overwhelm physicians and their administrators as they begin to realize what is required to support EHR technology in the private practice and the impact such applications will have on practice operations.

Stage 1, the initial period described in the proposed rule, defines use focused on capturing health information electronically so that key clinical conditions can be tracked and patient care coordinated. Physicians will be expected to implement clinical decision support tools for disease and medication management.

Criteria for meeting Stage 1 of meaningful use include maintaining an up-to-date problem list, generating and transmitting at least 75% of all permissible prescriptions electronically, maintaining an active medication list with at least 80% of all unique patients, and having a least one entry providing clinical summaries to at least 80% of all patients for each office visit. You can see this will, indeed, change the way most urologists currently work and manage their patients' health records.

Under the proposed rule, qualifying for the stimulus funds also requires physicians to use certified EHR technology "in a manner that improves quality, safety and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information."

The proposed Centers for Medicare & Medicaid Services requirements set the minimum standard for acceptable EHR use, which at this time means being certified by the Certification Commission for Healthcare Information Technology, but more certification organizations are expected to emerge later this year. Certifying bodies rate products on usability and ensure that vendors meet the major objectives of meaningful use.

Start gathering information now

Yes, it may be time to start planning and gathering preliminary information. At the same time, until the proposed legislation is finalized, urologists will not have essential information to guide the decision process. At a minimum, it makes sense to start gathering information about health care information technology specialists who can protect the practice from making a bad decision and provide critical information to help make an appropriate EHR decision based on your specific practice and the final criteria once it is passed.

Certainly, the government's financial incentives are designed to persuade many physicians to finally get on board with an EHR system, and will be effective in doing so. But don't leap into it without a clear understanding of the government's final requirements.

It will be important to take a practical approach, as well. It is a long and arduous road to go from deciding to move forward to identifying the financial requirements and making a product decision. Make sure you are armed with the tools you need to make the EHR decision that best fits your practice.

Judy Capko is a health care consultant and the author of Take Back Time-Bringing Time Management to Medicine . She can be reached at 805-499-9203 or

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