Meaningful Use is a federal program that aims to improve healthcare in the US through the use of electronic health records (EHR) by establishing objectives and measures that eligible hospitals and professionals must meet. The goals are to engage patients, improve care quality and coordination, and advance public health. However, many hospitals face challenges in understanding requirements, gaining staff buy-in, and meeting clinical quality measures. Successful strategies include studying workflows, identifying advocates, training clinicians, and supporting mobility and security. Stage 2 criteria will be more stringent and failure to meet Meaningful Use can impact federal funding.

1. Meaningful Use
More Than IT

2. Meaningful Use for Hospitals
Meaningful Use: Using certified EHR technology to improve quality,
safety, efficiency, and reduce health disparities in healthcare.
Goals of Meaningful Use:
• Engage patients and families in their healthcare
• Improve quality of care
• Improve care coordination
• Improve population and public health
• Maintain privacy and security

3. Biggest MU Attestation Challenges
• Understanding the requirements
• Hospital staff buy-in
• Physician/clinician trust
• Vendor scheduling
• Clinical quality measure reporting
• Interdepartmental coordination
Source: HIMSS

4. Reaching Stage 1
• 110,000 Eligible Professionals attested & received funds (20% of
all eligible professionals)
• 2,400 Hospitals attested & received funds (48% of eligible
hospitals)
Source: Health Data Management

5. Meaningful Use Timeline
Source: http://assistancecenter.missouri.edu

6. Meaningful Use Objectives
Eligible Hospitals must complete (Stage 1):
• 14 core objectives
• 5 objectives out of 10 from menu set
• 15 total Clinical Quality Measures
Eligible Hospitals must complete (Stage 2):
• All requirements build on Stage 1 reqs.
• 16 core objectives
• 2 objectives out of 5 from menu set
• 49 total Clinical Quality Measures

7. KPMG Study
• 71% of hospitals report being more than halfway to completion of
the adoption of EHR, but only 48% confident they will meet Stage
1 of MU
• Barriers reported:
– Difficulty understanding the requirements
– Training and change management efforts
– Data capture
– Generating the metrics required

8. RWJF Study
• Those close to accomplishing MU:
– 40% had not implemented drug-drug and drug-allergy interaction
checks
– 35% could not provide patients with a copy of their record
– 30% had not implemented computerized physician order entry
(CPOE)

9. Heart of the Issue
• Clinician resistance
– Getting clinicians to use the EHR as part of their daily work,
particularly those physicians that are affiliated with, but not
employed by the hospital
• Security and compliance
– Unattended workstations/devices with patient data
– Passwords that are shared, written down
– Tightening security creates more tasks for clinicians, creating a
vicious circle

10. Solution Approaches
• Study and understand workflows
– Workflows vary significantly from department to department
– Focus on functions throughout the clinician’s day and across
departments
– Understand the value of order sets and coordinate their use within
the EHR system
• Identify advocates and super-users
– Clearly identify workflow improvements and other visible clinician
benefits
– Focus on those clinicians who are most difficult and take the time to
get them the one-on-one support they need

11. Solution Approaches
• Use clinicians to train clinicians
– Provides the trainee with the support of someone who understands
the delivery of care
– Make training available at the convenience of the physician
– Have on-demand training tools available
• Implement single sign-on
– Particularly where security has been increased, tasking the clinicians
with signing in and out repeatedly creates frustration
– Immediately unburdens the clinician from password management
– Consider passive proximity devices and biometrics

12. Solution Approaches
• Re-authentication for ePrescribing and CPOE
– Consider similar proximity/bio-authentication approaches
• Support clinical roaming
– Virtual desktops allow clinician access wherever they may be in the
facility
– Allows opening a patient record in one location, then accessing it
immediately in another

13. Potential Impact of Stage 2 Criteria for MU
• Increased thresholds
• Menu measures moving to Core measures
• Impact of 40% imaging requirements
• Clinical decision support rules from one to five required
• “Packed” versus “unpacked” order sets

14. IT/Operational Issues Impacted by MU
• Inpatient EHR/PM
• Ambulatory EHR/PM (if different from inpatient)
• Mobility platform
• Storage, data backup/archive
• Hospital’s progress to the cloud
• Privacy & Security
• Clinical workflows
• Hospital/physician alignment

15. Wrapping up
• Meaningful Use is a strategic, long-term program for hospitals
• It impacts both legacy systems as well as newly adopted
technology
• Meaningful Use is primarily a human challenge, solid clinical
workflows are imperative for success
• Can’t attack MU as IT vs. Operations – the two must work together
and coexist

16. Thank you for attending!
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