Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities

Abstract

BackgroundWith the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems.ObjectiveThe Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy.MethodsWe gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group.ResultsStakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs.ConclusionsAlthough MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.

Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial

“…3,4 Electronic health records hold promise to improve patient safety, quality of care, physician efficiency and performance, patient-physician communication, patient participation, cost of care, and health outcomes. [5][6][7][8][9] There is also growing evidence, however, that in their current state, EHRs are associated with decreased physician productivity and revenue, 10 negative patient-physician interactions and relationships, 11 and widespread physician dissatisfaction. [12][13][14] More than one-half of all US physicians experience burnout, with primary care physicians having one of the highest rates.…”

Sorting out EHR adoption and assimilation in the Meaningful Use incentive program in Hawaii

“…In particular more attention to understanding what the specific needs are for rural and smaller physicians, who serve unique population health needs of these communities [33], is needed. MU policy may evolve to allow for a more flexible orientation for those providers still lacking in EHR to adopt and assimilate the innovation in order to support broader health care reform.…”

“…Policymakers may have underestimated the impact meeting MU program requirements would have on organizations. Although HITECH provides some incentives and implementation support resources, many organizations face the ongoing issue of diverting time and attention to simply meeting basic MU requirements, diverting attention from finding solutions to other local and national health care reform priorities [23] [33].…”

Does Tall Man lettering prevent drug name confusion errors? Incomplete and conflicting evidence suggest need for definitive study

“…One reason to demand more evidence prior to implementation is the opportunity cost of implementing any error-prevention measure 25. Health information technology staff represent a finite resource whose work must be carefully prioritised, especially in this era of proliferating quality measures related to ‘meaningful use’ of electronic health records 26.…”