Most Concerning Part of Meaningful Use

Seems like we’re just about out of the daze that is the mammoth meaningful use final rule (yes, I know that other rules are even bigger, but it’s still mammoth). I thought it would be interesting to ask what’s the part of meaningful use that’s most concerning. Just so we’re not always pessimistic, I’ll follow up this post next week with one asking people to share the most exciting part of meaningful use. Both answers should be interesting.

While I don’t want to bias your comments, I will say that the thing that concerns me most about meaningful use is physicians going deep into debt for an EMR system they barely want in the hopes of EMR stimulus money and then end up with no stimulus money.

The first concern with this is those physicians that think they have to go into deep debt in order to fund an EMR. In most cases, this can generally be avoided. There may be some debt involved, but it should be pretty minimal and the return on the investment should be understood from the beginning and should not include the EMR stimulus. Unfortunately, I fear that many won’t heed this advice.

Add on the past experience with government handouts and I can see many appropriately disgruntled providers who get left holding the bag which includes no stimulus money.

Ok, your turn. What concerns you about meaningful use?

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Perhaps this blog could set up a “vote your opinion” asking whether readers think government efforts to promote EMR usage are 1) a net positive, 2) a net negative, or 3) no effect on EMR adoption. A follow-on question pull-down menu would classify the responder (doctor, clinic, EMR vendor, etc.).

    The results might be interesting.

  • In addition to financial concerns about the USA in general, I worry that EHR vendors will become very inundated with new clients in the next few months. This may lead to extended implementation time-lines, extra costs; and most importantly, a less than optimal deployment environment for end users.

  • I think the most difficult part will be the reporting. The data points that will be required are not really a part of the applications and will have to be derived from other data. This will will be time consuming and difficult. In addition, how will they be audited? Many decisions yet to me made.

  • One concern I read early on and that still applies is the nature of percentages in some of the requirements. For example, providers must attest that more than 40% of prescriptions are transmitted electronically using certified EHR technology. That appears very flexible and doable. Here’s the hitch: an IT person has to spend the same amount of time making that function work whether 1% or 100% of prescriptions are made this way. Same for training: the provider has to spend the same amount of time learning how to use this function, regardless of how many prescriptions he eventually makes with it. So there’s not that much flexibility here, or with many of the other percentages.

    I do think it’s good that the percentages were lowered, so that providers can take more time to really learn to use these features without the pressure of having to get every attempt 100%. However, I think they should realistically know that the same amount of work will still be required to learn this technology.

  • David,
    I agree that a poll could be interesting. I’ll see about putting one up.

    We’ve been hearing rumors about this supposed backlog for EMR vendors for a long time. I’m feeling like it’s never going to happen. We’ll see, but the more I think about it the more I think that it’s not going to be an issue.

    If you have to derive data points for Meaningful Use, then it’s going to be an ugly application process.

    Interesting look at the work. However, I think the percentages were most implemented to deal with situations where you can’t ePrescribe (ie. Controlled Substances) or when it doesn’t make sense to do it.

  • John, I think the evidence of vendors who are starting to have back-ups in their installs is starting to appear. We have a client who signed their agreement – and made a 50% deposit – at the end of July, and was told that the vendor is now scheduling training in November and December of this year. The vendor is one of the “biggies” so I think it’s fair to assume this will be affecting all of them soon. Some vendors also ask for payments on a schedule that results in 100% payment to the vendor before any implementation and training has been scheduled, let alone completed.

    As for MU criteria, the good news is that any certified EHR technology is required to have the capabilities to track and report on all current Core and Menu objectives, and even some of the capabilities that didn’t make it onto the list, such as electronic eligibility and claims submission.

    It is certainly true that practices will make just as much effort to use the system for 40 or 50% level of use, as they will for achieving 100% use for each objective. Many current users will tell you that they get the most benefit out of their system when they use the capabilities to the max, so if you are installing a system, make the effort to get the most out of it. That will improve your qualitative and quantitative ROI!

  • Jim,

    Are we sure that training wasn’t scheduled that way in order to allow time for system set up, building tables, etc…prior to user training? Or perhaps you’re referring to initial training that shows client how to begin set-up, in which case we are certain it is a vendor backlog issue?

    This is an issue I am trying to keep abreast of as we have not yet selected from our 2 finalist vendors. Thanks!

  • Jim,
    Reminds me of the recent comment about the 4 hour demo by the EMR vendor. I guess I just have a preference for an EMR vendor that can demo in an hour and then turns over the system to you for the next 3 hours (or less) to get a good hands on feel for the system. Plus, if it takes them 4 hours to demo it, imagine the training required.

    I honestly don’t understand why users are still paying the HUGE up front lump sum payment. There are so many offering the nice monthly fee per provider and most of the time that will amount to less than the large lump sum payment. Plus, the monthly payment matches the way a doctor gets paid much better.

    Then, to think that they’d pay a HUGE amount up front and then wait 6 months is just funny. Better test their support line as well. See how quickly you get a response.

    I guess my point being that there’s plenty of alternatives. Hmmm…I think you just gave me the idea for my post today.

  • Wes, this was the training to allow the staff to begin the implementation process, so it definitely is a vendor issue. Sometimes all other things are equal, and earlier availability of training can be a deciding factor. But if all other things are not equal, then sacrificing a few weeks until the vendor can start on training may be a good choice so you get the product most suitable to your practice.

  • True, just because you purchase a certified EMR does not mean automatic stimulus $’s. Providers will still need to prove meaningful use themselves. Hopefully the EHR vendor will provide the tools and backup support/monitoring to help the physician with this goal.

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