The Meaningful Use Decision – Meaningful Use Monday

What else could be written about meaningful use that hasn’t already been said? Really. I’ve been thinking this over since I think we’ve been writing about the EHR incentive money and meaningful use for almost two years now.

I still remember the first time I read about the government planning to give out incentive money for those who adopt an EMR. Some thought that they’d just give out the money to doctors who adopt an EHR kind of like they did for those who purchased a home. I guess the government assumes that when you purchase a home you’re going to use it, but when you purchase an EHR that’s not always the case. So, meaningful use was born.

One of my biggest problems with meaningful use has always been its conflict with certified EHR. I’ll never understand why the government wants to certify EHR software (ie. more expense) when they could have just built the requirements of meaningful use so that the only way for a user to meet the requirements is by using an EHR software that performed the functions required. I guess I can partially see some security checks that could be done in an EHR certification that wouldn’t show in meaningful use, but does anyone really think that EHR software is much more secure thanks to EHR certification?

Of course, much of this is water under a bridge. We have meaningful use and certified EHR and there’s no going back now.

At this point, I wonder how many doctors are still undecided on meaningful use and EHR software. Considering all the discussion and chatter, I feel like most doctors have made the decision on the subject. They’re either going to use an EHR or not. I guess there might b e a few doctors that want to use an EHR, but are waiting for the right one. Certainly there are many doctors that know that EHR is the future, but they just haven’t committed the time to evaluating the various EHR software and deciding which one is best for their office.

My gut feeling tells me that the EHR incentive money wasn’t enough for many of them to finally get down to the business of selecting and implementing an EHR. I imagine many of them are waiting and hoping for a clear EHR market leader to emerge. I’m sorry to inform them that I don’t think that’s going to happen for another 2-3 years at least. Plus, I still think we might have market leaders in each medical specialty.

I’ve heard some argue that it’s the future meaningful use stages that have people scared to implement an EHR. Basically, they believe that meaningful use stage 1 is reasonable, but they think that meaningful use stage 2 & 3 will be much harder and not worth the effort. Kind of reminds me of the arguments that businesses have made about the uncertainty of economic policy causing them not to “move” on more investments. I think many doctors are uncertain about the EHR stimulus money, future stages of meaningful use, and how private insurance companies may react in the future. This uncertainty does cause issues for their ability to plan.

One thing I think the EHR industry could do to provide more comfort to doctors is to provide doctors that adopt your EHR a pathway to leave your EHR if you don’t meet their expectations. Why vendors try to lock someone into their EHR that hates it is beyond me. Ok, I get the short term gain and why you hate losing customers. However, by locking them into a product they don’t like you’re creating an eternal enemy to your product and believe me when I say that doctors talk. Plus, if you have doctors that want to leave because your product doesn’t meet their expectations, then you have a bigger issue on your hands. Sure one or two that have work flows that don’t match your product, fine. A mass exodus from your product because you chose to make it easy for them to leave means you should probably fold up shop anyway or fix the reasons why they want to leave.

Unfortunately, the large EHR vendors won’t really care at all. They’re all about lock in whether you like it or not. I hope doctors start to kick against this and support EHR vendors that provide pathways out of their product. I’d still be happy to support a movement to “liberate” EHR data. Any EHR vendors want to join?

This brings us back to meaningful use. It’s too bad the meaningful use didn’t require practical elements that would make a lot of sense for government to institute. For example…
-Require EHR vendors to create an easy export of all patient data
-Require EHR vendors to communicate with other EHR vendors
-Require EHR vendors to send public health data (they’ve kind of done this)

I’m sure there are more, but that’s a good start.

Now the most interesting thing is going to be how this first wave of meaningful use doctors react to the EHR software they’ve chosen. Unfortunately, I’ve really only seen meaningful use doctors who’ve had an EHR software well before the term meaningful use was coined. If you are a doctor who recently implemented an EHR post meaningful use, I’d love to hear from you so we can tell your story.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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.


  • I haven’t seen any recent numbers and the numbers that have been out are generally guesses as well. I personally put the number somewhere at about 25% based on anecdotal experience and talking with many EHR vendors.

  • First, I am a vendor of a certified EHR (Aquarius EHR powered by NeoMed) and agree with John on many aspects of his post. The market is filled with half truths and misconceptions (blame the government for making it all so complicated). Reminds me of a joke I once heard about software salesman (easily modified to EHR salesmen). Whats the difference between a EHR salesman and a used car salesman? The used car salesman KNOWS when he is lying!

    Regarding the “Practical Elements” at the end, I would like to point out that to be certified and EHR must be able to create (export) and import the Continuity of Care Document (CCD) which is a standardized format for exporting and importing patient data. This effectively provides for his first 2 practical elements.

    The CCD file is essentially an XML file with all the patient data (including encounter, lab, orders, allergies, drugs prescribed, etc.) an included style sheet (viewing template) that allows patients to view their data in a simple organized format.

    EHR’s must be able to import these into their EHR in order to become certified providing for standardized electronic exchange of patient data between multiple certified EHR’s and giving portability to the patient record.

    Should a end user want to convert their certified EHR they need only to export their patients data into CCD files and then import them into a new certified EHR (most support batch import of multiple patients)

    On the issue of Meaningful Use vs Certification…. the government learned from the e-prescribe incentive program when it engineered the EHR incentive program. The certification standards are designed to provide specifications (like the format of the CCD file mentioned above).

    E-prescribe had these specifications that were necessary to clearly define how data was formatted for interchange (the biggest challenge to making health records electronic) the problem was the incentive just specified that you had to have one and use it but did not specify how often. Many physicians signed up, collected the incentive, and continued to write paper prescriptions. For this reason the government decided to require having a certified EHR AND demonstrate that they were using it in a meaningful way.

  • Mark Wright,
    I love the joke. I’m going to have to use that for a future post.

    As far as the CCD files, have you ever tried to take CCD files from the other vendors and import them into your system? They all have slight tweaks that require the import to adjust for each EHR vendor. Someone recently told me that there are even different flavors of CCD standards. Which of course begs the question, what kind of standard is that?

    Interestingly, I’ve been approached by a vendor to create a third party service that would aggregate all the various CCD files from the various EHR vendors. That way each vendor could use all the files to test out their CCD import tools across all the various EHR created files. Let me know if you’d be interested in participating and I can let you know what comes of it.

    Also, the CCD doesn’t contain ALL of the patients data. I think it’s best described as a summary of the patient data. Some might describe it as the most important parts of a patient data. However, it doesn’t yet include things like uploaded documents and audit trails to name a few. Basically, if I’m a doctor that moves from one EHR to another EHR, I can’t just export a bunch of CCD documents and import them into my new EHR if I want to preserve all the patient data. At least that’s my understanding.

    Hopefully CCD or some standard XML output will reach this point where I could switch EMR software easily using a standard export. That would make me very happy.

    As far as the MU vs. certification, you haven’t really illustrated why certification is needed if it’s covered in MU. If you require a doctor to use the CCD standard as part of MU, then why do you need certification? They won’t be able to use the CCD standard if the EHR can’t perform the task needed. So, by default the EHR will have to conform to that standard.

  • I “love” it when folks in the EHR biz talk about standards.

    What version of the standard are “you” on?

    Is it backward compatible?

    There is no true exchange format.

    I know because I’m dealing with this problem waaay toooo much.

    This is a major issue in my opinion.

  • I agree, John, with this comment of yours, and certainly see the coming emergence of market leaders in the specialty of radiology (where a cloud-based solution is the best answer for rads who read in several locations):

    “My gut feeling tells me that the EHR incentive money wasn’t enough for many of them to finally get down to the business of selecting and implementing an EHR. I imagine many of them are waiting and hoping for a clear EHR market leader to emerge … Plus, I still think we might have market leaders in each medical specialty.

  • Exchange between community based EHR systems is a good place to start to enable patients to move between practices and to allow for EMR software takeover or going out of business.

    The UK moved on this a few years ago and has a HL7 V3 message for transfer of what I understand is all significant data. New Zealand is working on the same using HL7 CDA – the underlying XML document standard for CCD.

    As regards variations and implementability of standards there is an organisation dedicated to a final tweaking and tightening and TESTING of standards called Integrating the Healthcare Enterprise (IHE). They have developed for example the document sharing profile used in HIEs. The way to sort out the variation in CCD is to get your industry or professional organisation or vendors to push this up through IHE.

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