Hardest Meaningful Use Measure

There was a great piece a while back by Benjamin Harris that looked at the 5 not-so-easy pieces of meaningful use stage 2. In the article he suggests the following 5 challenges:

1. Structured Lab Results
2. Patient Access to Health Information
3. Ongoing Submission to Registries
4. Computerized Order Entry (CPOE)
5. Summary of Care Referrals

I started asking around my network to see what readers of my site and those in my social media groups thought was the hardest meaningful use measure for them. Some of them match the list above, but I thought I’d highlight a few of them I found interesting.

One person told me that the multi-lab scenario might be one of the most challenging parts of meaningful use and one that doesn’t get talked about much.

A CIO named Renee Davis told me that ePrescribing and monitoring compliance were the hardest meaningful use measures. I think the ePrescribing part can be a huge challenge depending on your EHR vendor, your physician users, and your location (ie. Do your local pharmacies participate?). Plus, any CIO will definitely have challenges with compliance.

Patty Houghton suggested that Clinical Summaries and Problem Lists were her hardest meaningful use challenges.

Obviously when you say the word “hardest” it’s something that’s unique to an individual practice or institution. With that disclaimer, from the large number of people I’ve talked to I think that most people consider the 60% CPOE meaningful use measure the hardest.

I still remember the day when I heard Marc Probst, CIO of Intermountain Healthcare (IHC), say that IHC was doing ) CPOE. This was when he was first working on the committees in Washington to create EHR certification and meaningful use requirements. It was a shock to me that IHC, who is touted for its use of IT in healthcare, could have 0 CPOE (I think Meaningful Use has helped encourage them to remedy this number). It illustrated well how much of a challenge CPOE will be for many institutions.

What’s your experience and the experience of the doctors and hospitals you work with? Which meaningful use measures are most challenging?

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, 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, EXPO.health, 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 think some people may be confusing Stage 1 with Stage 2. I believe incorporating lab results is a menu item in Stage 1 but moves to core in Stage 2.

    I hear that providing clinical summaries is the most difficult stage 1 requirement. In general this is because providers are not used to finishing most of their note before the patient leaves the office. As such, they then have to “snail mail” the summary (expensive!) or send it through a portal, which may cost extra with some EHRs or be a cumbersome process.

    When stage 1 was anticipated I don’t think most providers thought the clinical summary would be so challenging.

    Similarly, until providers experience stage 2 they won’t really know what is the most challenging. At this point most are fearing the patient portal requirement, and in particular the requirement that at least 5% of patients use the portal to send a message. Providers are rightly concerned about a measure they cannot really control.

  • I think the electronic transmission of care requirement (5%) will be difficult for a few reasons:

    – CMS is asking providers to change their workflow from printing & faxing referral letters to using a CCDA document and sending it electronically

    – The providers I know, have painstakingly crafted their referral letters to communicate specific data, are they going to be happy about shifting to a generic CCDA?

    – Depending on your EHR’s vendors implementation of Direct, this could be very difficult, e.g., some may require you to go to a separate web portal to send the Direct message… not very efficient

    – You are also putting a burden on a practice to manage a separate directory of Direct email address…

    – What if the providers you refer to haven’t jumped on the Direct train?

  • Cathy,
    Yes, I did go a bit back and forth between meaningful use in general and MU stage 2. I should have been more specific about that. Either perspective is interesting though.

    Great additions to the discussion from both of you. I agree that doctors hate that they are “judged” on something they don’t control (patients’ actions). There are a number of exchange issues that could be a problem like you describe JW.

  • I picked this up on Twitter today as an “old post”, but I’m glad you sent it again.

    We’ve had relative success, and I stress relative, in making it as easy as possible in our EHR for our doctors to attest for Meaningful Use Stage 1 as one independent poll showed.

    But with MU2 it is getting much harder. There are requirements that demand additional data entry, whether typing, clicking, or dictating that no EHR vendor can help doctors avoid.

    What I like about you tweeting this old post is that I can look at the comments and compare those concerns with what we’ve done in-house to design the best solution possible.

    My greatest concern is that doctors look at the changes needed to their workflow and decide the incentive is not worth it. I think there are some MU2 requirements that are very cool from a healthcare technology perspective (and as a patient), but one could certainly argue that giving doctors the features they’re asking for that are not in MU2 may be more valuable to them adopting EHR technology than some features they don’t want that are in MU2.

    We’ll definitely find out in early 2014.

  • Swithin,
    I think your concern is becoming a reality for many doctors. I think many doctors will opt out of MU because they don’t see value in stage 2. Much of the complexity is unavoidable in MU stage 2.

Click here to post a comment