Bringing up Your EMR in an Era of Meaningful Use

By now I assume most of you have read the recently released final rules for Stage 2 of Meaningful Use – or at least the plethora of synopses available online. (It wouldn’t hurt to read what Lynn Scheps wrote about meaningful use stage 2 over at

Whatever level of knowledge you may possess about these rules and how near or far they deviate from those proposed, I think we can all agree that the EMR industry (developers and end-users) is suffering immense growing pains as vendors and physicians adjust to the Meaningful Use scheme. (I use that term in the British sense, by the way.)

Julie McGovern, CEO of Practice Wise, cleverly equated implementation of an EMR to being pregnant in a recent blog:

“In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.”

I’ll go one step further and equate utilization (i.e. the regular use of an EMR after go-live) as relates to the various stages of Meaningful Use with bringing up that baby. I might even disagree with her – pregnancy is often the easy part (provided you’ve had no complications along the way, of course, be they IT, managerial, administrative, cultural or otherwise). You’ve got the PR-friendly ribbon-cuttings, parties and press releases that hospitals often initiate around their go-lives. Well-deserved events, to be sure. But then come the hard parts, when you and your colleagues integrate that new bundle of joy into your daily lives (i.e. workflows).

Eventually the EMR will develop its own personality, form bonds with its users, bring joy to many for the clinical outcomes it improves, and hopefully not cause too many tears of frustration along the way. Hopefully it will gossip with its peers at other hospitals, and even aspire to interoperate in the same circles as its distant cousin – health information exchange. You can bet that it will end up costing more money than you had anticipated – upgrades, add-ons, etc.

The years will go by – 2014 and 2016 will be here before you know it. Hopefully, the EMR that caused so much joy when it was first brought into this world shiny, new and virus-free will still bring a smile to the face of its users, and better care to the patients whose information it so closely guards.

About the author

Jennifer Dennard

Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.


  • Ahhh- but John, you’ve never compared EHR/MU to Death! The current Federal Government involvement in HIT is to providers more like the 5 steps of death and dying:

    1) Denial and isolation: “This is not happening to me.”
    2) Anger: “How dare Obama do this to me! What a jerk!”
    3) Bargaining: “Please Obama- just let me continue to survive under Medicare.”
    4) Depression: “I can’t bear to face going through this, I’m meaningfully depressed.”
    5) Acceptance: “I’m ready to empty my pockets, go into debt, and possibly buy an expensive EHR or just retire… I don’t know. All I know is that I don’t want to struggle anymore.”

    I, for example, am perpetually stuck in step 2. I continue to buck the system whenever I can. I’ve actually quit doing hematology/oncology and streamlined my [now] internal medicine practice to survive in these tumulous waters. Result: as more than 60% of the offices next to Virginia Hospital Center [my admitting hospital] have closed and been bought out by the hospital, I’m part of the less-than-40% that have survived. My income for 2011 will most likely show a doubling of my personal gross income.

    As I’ve become a “nonpar” Medicare provider, I initially lost many Medicare patients, but I’ve gained what I want now- cash paying and younger PPO/HMO patients to fill in the empty slots. Many Medicare patients now have come back too, because I give them attention and the best care that I can offer. They pay me up-front using the “nonpar” Medicare contractual scale. THEY end up paying the current (s.a. eRx) and future penalties that Medicare will shell out, which is what always happens when big government taxes businesses- the clients end up paying the bill.

    Some go through to step 5, buy an EHR, then either deinstall their systems, become hospitalists (or go to another endeavor), or retire. I plan on NOT going through these routes, at least for the next 10 years.

    What needs to occur is that the Federal Government has out of HIT. Until that happens, we will never achieve a true “meaningful use” of EHR systems. Yes, doctors will get into inexpensive EMRs (like I have), but they will never buy into something that they cannot afford in both time and money. If EHR/MU continues, you’ll see Medicare suffer as doctors opt out or become “nonpar” making it difficult for the elderly to get the care that they need.

  • Dr. Borges, thank you so much for that thoughtful comment. I am very interested in learning more about the path you’ve chosen in the face of constant pressure from all sides.

  • Gregory,
    Jennifer Dennard wrote the post, but she always has thoughtful comments as well. The redesign of my websites is almost complete and in the redesign we highlight the author of the article much better.

    Personally, I’m a big fan of specialty EHR. From my anecdotal experience the satisfaction rate among specialty EHR is higher than the one size fits all EHR. I just wonder how many will survive with the trend of hospitals acquiring practices.

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