Attaining Meaningful Use of Health Information Technology in a Residency Program: Challenges and Rewards

Abstract

The US Federal Government has offered financial incentives to physicians and hospitals for using health care technology in ways that may improve the quality of patient care, via the use of an electronic health record. Although many barriers exist to achieving the health care technology requirements necessary to capture these incentives, several strategies were employed by the University of Hawai‘i Family Medicine Residency Program at the Physician Center at Mililani to overcome these barriers, in order to register and attest for these financial rewards. The rewards are substantial, and may total up to $44,000/eligible provider over 5 years, and $63,750/eligible provider over 6 years, for Medicare and Medicaid respectively. Both programs have different incentive payment schedules for hospital facilities. This article intends to outline the process and challenges involved in meeting the specific requirements necessary to qualify for this funding, and to assist others in this endeavor, particularly (but not limited to) residency training programs, which face a unique set of challenges.

Background

The Institute of Medicine (IOM) report released in July 2006 documented 1.5 million preventable medical errors annually in the United States. One major recommendation from the IOM was to use health information technology (HIT) to help reduce these errors, and improve quality of health care.¹ In February 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), providing stimulus funding to help accomplish this goal, via the Health Information Technology for Economic and Clinical Health (HITECH) act, codified as Title IV of the larger ARRA package.

Title IV Health Information Technology: Adoption and Use of Health Information Technology invests in the adoption and use of HIT systems by health care providers who serve Medicare and Medicaid patients. This act provides temporary bonus payments to meaningful users of certified HIT and will phase-in Medicare payment penalties for non-adopters starting in 2015 for eligible providers who have not met meaningful use by 2014.

Title IV allows Critical Access Hospitals (CAHs) to receive up to $1.5 million in total Medicare bonus payments and has goals of achieving a 90 percent adoption rate for physicians and 70 percent adoption rate for all hospitals, with a 70 percent adoption rate for acute care hospitals and a 60 percent adoption rate for CAHs.

The $19 billion HITECH program through Medicare and Medicaid provides financial incentives to health care providers and institutions for the Meaningful Use (MU) of Health Care Technology, via the use of Electronic Health Records (EHR). The goals of MU are to improve quality, safety, and efficiency while reducing health disparities, engaging patients and families, improving care coordination, improving population and public health, and ensuring adequate privacy and security protections for personal health information. Providers can apply for either the Medicare or Medicaid incentive program; however, there is a procedure whereby an eligible provider may switch incentive programs one time only.²

Payment Schedules and Requirements for Eligible Providers (does not apply to hospitals):

1. Medicare: Maximum amount attainable = $44,000/provider over 5 years ($18,000/1st year, decreasing yearly amounts thereafter)

2. Medicaid (must have at least 30% Medicaid patients, and state must be participating): Maximum amount attainable = $63,750/provider over 6 years ($21,250/1st year, subsequent annual payments of $8,500 for up to six years total³

The University of Hawai‘i Family Medicine Residency Program (UHFMRP), whose clinical operations are centered around the Physician Center at Mililani (PCM) chose to have its faculty physicians apply for the Medicare incentive program, in part because at the time of registration, the State of Hawai‘i was not able to enroll providers in the Medicaid program. The electronic application is available on the Center for Medicare & Medicaid Services (CMS) website (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp). In order to qualify for funding, there are core measures, menu items, and clinical quality measures, which must be met and documented by the certified EHR. For MU Stage 1, there are exclusions to the core (see Table 2) and menu (see Table 3) set that some EPs can choose in order to reach MU.

Table 2.

Core Measures for achieving Meaningful Use

Core Measure	Definition
Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines	More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication entered using CPOE
Implement drug-drug and drug-allergy interaction checks	The EP has enabled this functionality for the entire EHR reporting period
EP Only: Generate and transmit permissible prescriptions electronically (eRx)	More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology
Record demographics: preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH	More than 50% of all unique patients seen by the EP have demographics as recorded structured data
Maintain up-to-date problem list of current and active diagnoses	More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data
Maintain active medication list	More than 80% of all unique patents seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data
Maintain active medication allergy list	More than 80% of all unique patents seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data
Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2–20 years, including BMI	For more than 50% of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data
Record smoking status for patients 13 years old or older	More than 50% of all unique patients 13 years or older seen by the EP have smoking status recorded as structured data
Implement one clinical decision support rule and the ability to track compliance with the rule	Implement one clinical decision support rule
Report clinical quality measures to CMS or the States	For 2011, provide aggregate numerator, denominator , and exclusions through attestation; For 2012, electronically submit clinical quality measures
Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request	More than 50% of all unique patients of the EP who request an electronic copy of their health information are provided it within 3 business days
Hospitals Only: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request	More than 50% of all patients who are discharged from an eligible hospital or CAH who request an electronic copy of their discharge instructions are provided it
EPs Only: Provide clinical summaries for each office visit	Clinical summaries provided to patients for more than 50% of all office visits within 3 business days
Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically	Performed at least one test of the certified EHR technology's capacity to electronically exchange key clinical information
Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities	Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of the EP's risk management process

Table 2 source: (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp)

Table 3.

Menu Items for achieving Meaningful Use

Measure	Definition
Implement drug-formulary checks	The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period
Hospitals Only: Record advance directives for patients 65 years old or older	More than 50% of all unique patients 65 years old or older admitted to the eligible hospital or CAH have an indication of an advance directive status recorded
Incorporate clinical lab-test results into certified EHR technology as structured data	More than 40% of all clinical lab test results ordered by the EP authorized provider during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach	Generate at least one report listing patients of the EP with a specific condition
EPs only: Send reminders to patients per patient preference for preventive/follow-up care	More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period
EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP	More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withhold certain information
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate	More than 10% of all unique patients seen by the EP are provided patient-specific education resources
The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation	The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP
The EP who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral	The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals
Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice (counts as public health measure)	Performed at least one test of the certified EHR technology's capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive such information electronically)
Hospitals Only: Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice	Performed at least one test of certified EHR technology's capacity to provide submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice (counts as public health measure)	Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically

Table 3 source: (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp)

There are fifteen core measures for Eligible Professionals (EP's) displayed in Table 2 including Computerized Provider Order Entry (CPOE), drug-drug and drug-allergy interaction checks, patient demographics, electronic prescribing, problem list, medication list, medication allergy list, body mass index (as calculated by the EHR from height and weight inputted by the provider), smoking status, clinical decision support tool, reporting clinical quality measures, providing patients with their health information, exchanging health care information, and providing security for patient information (See Table 2 for details). More specifically, for MU Stage 1, one core measure is dedicated to generating an electronic copy of the patient's health information including diagnostic test results, problem list, medication list, medication allergies upon request. Another core measure is the provision of clinical summaries for patients personal health record via an online patient portal, secure email, electronic media such as CD or USB flash drive, or by making a printed copy available upon request.

In addition to the core measures, there are ten menu items for EPs (see Table 3). Five of the ten menu items must be met for EP's to qualify for MU, including drug-drug formulary checks, incorporation of lab test results into the EHR, generating lists of patients with specific conditions, sending patient reminders, providing patients with electronic access to portions of their EHR, providing patient education resources, medication reconciliation, summary of patient care, transfer of immunization data to registries, and submitting electronic syndrome surveillance data to public health agencies (see Table 3 for details). One of the five menu items chosen must be a public health measure (either immunization registry or syndromic surveillance data). Finally, providers must meet six clinical quality measures (CQMs): three core or alternate core measures (see Table 4) and three measures from a list of 38 additional clinical quality measures listed in Table 5. The core CQMs include blood pressure screening, tobacco cessation intervention, and weight screening/follow up. The alternate CQM's include adult influenza immunization, childhood obesity screening/counseling and childhood immunization status (Table 4).³ The additional clinical quality measures focus on chronic disease management and preventative health services, such as diabetes mellitus, hypertension, pre-natal screening, and cancer screening, but include many other items (see Table 5).

Table 4.

Eligible Professionals-Core & Alternate Set CQMs^*

Core CQM
NQF Measure Number & PQRI Implementation Number	Clinical Quality Measure Title
NQF 0013	Hypertension: Blood Pressure Measurement
NQF 0028	Preventive Care and Screening Measure Pair: (a) Tobacco Use Assessment, (b) Tobacco Cessation Intervention
NQF 0421 PQRI 128	Adult Weight Screening and Follow-up
Alternate Core Set CQMs- From the Center for Medicare Services Website
NQF Measure Number & PQRI Implementation Number	Clinical Quality Measure Title
NQF 0024	Weight Assessment and Counseling for Children and Adolescents
NQF0041 PQRI 110	Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older
NQF 0038	Childhood Immunization Status

^*Must also meet 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from alternate set):

Eligible Professionals, eligible hospitals and CAHs seeking to demonstrate Meaningful Use in 2012 are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.

Table 4 source: (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp)

Table 5.

Additional Set CQM-EPs must complete 3 of 38

Diabetes: Hemoglobin A1c Poor Control

Diabetes: Low Density Lipoprotein (LDL) Management and Control

Diabetes: Blood Pressure Management

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

Pneumonia Vaccination Status for Older Adults

Breast Cancer Screening

Colorectal Cancer Screening

Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment

Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Asthma Pharmacologic Therapy

Asthma Assessment

Appropriate Testing for Children with Pharyngitis

Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Smoking and Tobacco Use Cessation, Medical Assistance: (a) Advising Smokers and Tobacco Users to Quit, (b) Discussing Smoking and Tobacco Use Cessation Medications, (c) Discussing Smoking and Tobacco Use Cessation Strategies

Diabetes: Eye Exam

Diabetes: Urine Screening

Diabetes: Foot Exam

Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol

Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

Ischemic Vascular Disease (IVD): Blood Pressure Management

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement

Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

Prenatal Care: Anti-D Immune Globulin

Controlling High Blood Pressure

Cervical Cancer Screening

Chlamydia Screening for Women

Use of Appropriate Medications for Asthma

Low Back Pain: Use of Imaging Studies

Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

Diabetes: Hemoglobin A1c Control (<8.0%)

Challenges

Although meeting the aforementioned MU criteria appears to be a basic achievement for any clinical practice with an EHR, in a residency training program, there are several factors which make it more difficult to accomplish.

First, in a residency-based clinic, there are multiple, transient providers at various levels of experience (including residents in training), often leading to incomplete, fragmented charts. Since there is no economic incentive for residents, many of whom will graduate before the financial rewards result in program improvement, there may be less motivation to comply with efforts to achieve MU criteria. It is also difficult to reach residents after they graduate to complete unfinished charts, exacerbating potential non-compliance with MU. Furthermore, since residents are apprentice physicians still learning their chosen profession, achieving MU criteria may be more difficult because they are learning patient care and the EHR simultaneously, and documentation may suffer as a result of this “learning curve.” Residents also tend to chart more slowly, leading to a longer chart turnaround time, resulting in more incomplete charts.

Second, residency-based clinics have multiple, part time faculty providers with limited clinical practice time. This may lead to decreased efficiency with EHR documentation from faculty physicians because their patient volume is lower than that of physicians in individual or group practice settings. Also, some faculty members tend to be delinquent with their own charting or signing off on resident charts, due to involvement with research projects or teaching duties.

Third, the limited funding sources available to most residency programs may cause financial difficulties in upgrading the EHR to achieve CCHIT certification, and upgrading hardware/workstations to increase charting efficiency.

Fourth, medical assistant (MA)/physician ratios are usually lower in residency programs. With less staffing, MA's are less able to help complete portions of charts (medication reconciliation, demographics etc.) to assist the provider in meeting MU criteria.

Fifth, another obstacle that may prevent a practice from achieving MU compliance is deficiencies in charting. At PCM, some of the common deficiencies included incomplete charts (provider charts or resident charts unsigned by faculty preceptor), incomplete problem lists, unspecified smoking status, incompletely or partially filled medication lists, absent BMI data, unlisted preferred language, and a lack of race/ethnicity information in the charts.

Action Steps to Achieve Compliance with MU

In order to achieve compliance with the MU requirements, there are several steps to consider, given the many challenges involved.

First, feasibility of applying for MU must be determined. It is important to note that in order to qualify, EHR use is required, and should be in use for some time for charts to be adequately populated. UHFMRP physicians at PCM had been using an EHR (Practice Partner) for nearly two years prior to application for MU, so documentation was nearly “paperless” at the time of application. However, the EHR software needed to be upgraded to a version compliant with the CCHIT requirements.

Second, hiring a consultant is recommended. For PCM, it was helpful to have an independent person evaluate health care delivery for systematic internal deficiencies, and work on rectifying them, without being belabored by multiple other clinical tasks. PCM is a hospital-owned entity, so Wahiawa General Hospital (WGH) hired a consultant to help with this process. The office manager, lead medical assistant (MA), front desk representative, and medical director met every two weeks with the consultant, who examined charts and clinic logistics for areas of improvement in order to meet MU criteria. An additional helpful local state-level resource for physicians implementing EHRs is the Hawai‘i Pacific Regional Extension Center (HPREC) (http://www.hawaiihie.org/rec). HPREC is the designated regional extension center of the Office of the National Coordinator for Health Information Technology for the State of Hawai‘i (http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_rec_program/1495).

Third, it is important for providers to consider upgrading existing software, hardware, and workstations. Functional workstation in all exam rooms is a must, in order to encourage efficient workflow. PCM replaced old computers (laptops on stands in exam rooms, and desktop computers at the nursing station and preceptor room) with new, standardized models, as many of the old computers were not adequately functioning.

Fourth, it is important to encourage “real time” charting. This method is more efficient and accurate; however, it requires practice to accomplish charting during the encounter while still ensuring that the visit is “personal” with the patient. During resident and faculty conferences, this point was stressed by both the medical director and residency program director, who also modeled this behavior with their own patients. Workstations in exam rooms assisted this process.

Fifth, it may be useful to publish/distribute lists of incomplete notes/unsigned charts, so providers are aware of their deficiencies. At PCM, the office manager published and distributed such lists twice monthly, and the medical director contacted providers who were not timely in their documentation.

Sixth, it is helpful to “Flag” patient charts as needed (ie, with “Note,” “To Do,” etc) so individual charts are marked to complete deficiencies. At PCM, the Front Desk staff, MA's, office manager, and providers all used this functionality of the EHR to post update reminders in charts on deficiencies in a number of areas such as demographics, treatment plans, additional medications, etc.

Seventh, it is important to encourage the inclusion of the patient's personal medical doctor (PMD) on the chart. This is often more difficult in a residency program due to multiple, transient providers, but may add some accountability to chart completion. Attempts at enforcing this were not very successful for UHFMRP at PCM due to the multiple resident providers, and, perhaps, a reluctance on the part of the providers to take ownership of patient care.

Eighth, it is recommended that Team Based Care is utilized, as it can assist with chart completion. For example, MA (or medical/pharmacy students) can be helpful with this task. Although medication reconciliation (confirmation/correction of medication list with patient) is a task often assigned to MA's, it was difficult to accomplish at PCM due to a low MA/provider ratio.

Ninth, another MU-related MA function may be to identify overdue health maintenance needs (ie, mammogram, flu shot, colon cancer screening), and alert the patient and physician. This MA function was partially successful at PCM when the clinic was not too busy, but was difficult to accomplish during periods of high patient volume.

Tenth, creating and using a secure portal with online access to patient records (patient, provider, consultant) can be useful too. The EHR at PCM had this functionality, but did not utilize it as well as hoped, although some patients did register for this access.

Eleventh, it may be helpful to join a research network to help organize EHR data. PCM joined the Practice Partner Research Network PPRNet and some PCM members met PPRNet representatives at a User's Group Meeting, where they learned to use the EHR more effectively, and agreed to share anonymous patient data. A research group at Medical University of South Carolina (MUSC) uses PPRNet data for quality of health care research projects. In return, PPRNet gives PCM quarterly reports on various parameters to improve patient care and reporting Quality Improvement (QI) projects. UHFMRP residents have a research requirement, and QI projects fit in nicely with this, while helping populate charts and improve patient care. Residents have also completed, or are working on projects on diabetic care, colon cancer screening, childhood immunization compliance, and others which are assisted by PPRNet data extraction and compilation. In addition to improving quality of patient care, these projects help meet MU requirements.

Additional Steps for Achieving Meaningful Use Registration

In order to apply for MU funds, one must first register with CMS via a computerized process. It is helpful to register faculty with a consultant's assistance before the attestation step, because problems may occur. PCM faculty encountered some problems in this area. For example, some faculty members at PCM were not listed as being affiliated with WGH by Medicare, Provider Enrollment, Chain and Ownership System (PECOS); also, registration was not completed by other faculty members.

Necessary items for registration include:

1. A National Provider Identifier (NPI): All eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must have a National Provider Identifier (NPI) to participate in the Medicare and Medicaid EHR Incentive Programs.

2. An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS): All eligible hospitals and Medicare eligible professionals must have an enrollment record in PECOS to participate in the EHR Incentive Programs. (Note: Eligible professionals who are only participating in the Medicaid EHR Incentive Program are not required to be enrolled in PECOS). If a provider does not have an enrollment record in PECOS, he/she should still register for the Medicare and Medicaid EHR Incentive Programs.

3. National Plan and Provider Enumeration System (NPPES) User ID and Password.

4. Payee Tax Identification Number (if reassigning benefits).

5. Payee National Provider Identifier (NPI) (if reassigning benefits).

Attestation

Once all of the above criteria are met, the next step is attestation. The first year of participation is verified by “attestation” (self-inputted data); after that, annual data must be submitted to CMS to qualify for payments. In order for providers to attest for the Medicare EHR Incentive Program in the first year of participation, MU criteria must be met for a consecutive 90-day reporting period. If initial attestation fails, a different 90-day reporting period may be selected that may partially overlap with a previously reported 90-day period. To attest for the Medicare EHR Incentive Program in subsequent years, meaningful use must be met for a full year.

Please note the reporting period for eligible professionals must fall within the calendar year, while the reporting period for eligible hospitals and critical access hospitals must fall during the Federal fiscal year. April 18, 2011, was the earliest an eligible professional, eligible hospital or critical access hospital could attest that they had demonstrated meaningful use of certified EHR technology under the Medicare EHR Incentive Program. Under the Medicaid EHR Incentive Program, providers can attest that they have adopted, implemented, or upgraded certified EHR technology in their first year of participation to receive an incentive payment. Medicaid EHR Incentive Program participants should check with their state to find out when they can begin participation.³

Benefits

The primary benefit of the incentive program is the substantial financial rewards associated with the program (in the case of PCM, up to $44,000/5yrs/provider for Medicare). Currently, all UHFMRP faculty have registered for MU, and will soon attest to meeting MU criteria. It is important to note that each registering and attesting provider does not have to be full-time, so a faculty with many full or part-time providers will benefit substantially, as each provider is eligible for the incentive payment. Eligible providers may only qualify for incentive payments at a single site. Accordingly, it is important for each provider to determine their primary site and only register as an EP at that single location.

Additionally, upgrading computer systems at PCM to attain MU has resulted in the use of more secure and efficient EHR software. Also, during the process of preparation for attestation, there has been improvement in completed notes, problem lists, medication lists, and other clinically important documentation tasks that have resulted in better medical records. Communication with other providers via electronic exchange of healthcare information is expected to occur in the near future, as more EHR's are able to “communicate” with each other. Similar improvements across the healthcare industry are likely to result in improved patient care, improved efficiency, and reduced costs.

Conclusion

Although there are many challenges involved in meeting MU criteria (particularly in a residency program clinic), the benefits are substantial, and will likely translate into improved health outcomes for the patient population served. Many of the MU requirements are very basic tenants of good medical practice, including proper documentation, good communication, and error prevention. Nevertheless, implementation can be a challenge to successfully incorporate into a busy practice setting. Hopefully, the addition of well-implemented health care technology will make these challenges easier to overcome by a growing number of providers in the near future. At the time of this writing PCM is in the process of attesting for MU.

Table 1.

Some MU acronyms to remember

A/I/U = Adopt, Implement or Upgrade

CAH = Critical Access Hospital

EHR = Electronic Health Record

EP = Eligible Professional

HPSA = Health Professional Shortage Area

EH = Eligible Hospital

CPOE = Computerized Provider Order Entry

CCHIT = Certification Commission for Healthcare Information Technology

Table 1 source: (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp)

Conflict of Interest

The author does not identify any conflict of interest.