Article Figures & Data
Tables
Barrier Type Typical Issues Situational Time needed to implement, records conversion, adverse effect on workflow or efficiency, organizational structure, organizational culture, incentives Cognitive/psychological Lack of belief in value, need for control, anxiety over change, anxiety over technology Liability Privacy, security management, data integrity Knowledge Ability to evaluate and select systems, training Financial Start-up costs, training costs, uncertain or misaligned return on investment Technology Technical support, complexity, inflexibility of systems, customization limitations, reliability problems, data exchange problems Workforce Skillsets of physicians, staff skills, managerial/organizational support, leadership Core measures (providers must meet all) No. Measure Threshold 1 Computerized provider order entry used to enter medication orders directly into the electronic record 30% 2 Drug-drug and drug-allergy interaction checks enabled Yes 3 Problem list of current & active diagnoses maintained 80% 4 Permissible prescriptions generated and transmitted electronically 40% 5 Active medication list maintained 80% 6 Active medication allergy list maintained 80% 7 Demographics recorded as structured data 50% 8 Changes in vital signs recorded and charted as structured data 50% 9 Smoking status recorded as structured data for patients ≥13 years 50% 10 One clinical decision support rule implemented Yes 11 Patients given the ability to view, download, and transmit their health information within 4 days of its availability to the provider 50% 12 Patients given clinical visit summaries within 3 business days of a visit 50% 13 Electronic health information protected by appropriate technology Yes Menu measures (providers must meet 5 of 9) 1 Drug formulary checks enabled Yes 2 Clinical laboratory test results recorded as structured data 40% 3 Condition-specific patient lists generated Yes 4 Patient reminders of preventive or follow-up care sent 20% 5 Appropriate, patient-specific education resources identified 10% 6 Medication reconciliation performed 50% 7 Transition of care summary provided for each transition of care 50% 8 Capability to submit data to immunization registries implemented Yes 9 Syndromic surveillance data submitted to public health agencies Yes Core measures (providers must meet all) No. Measure Threshold 1 Computerized provider order entry used for medication, laboratory, and radiology orders 60%, 30%, 30% 2 Permissible prescriptions generated and transmitted electronically 50% 3 Demographics recorded as structured data 80% 4 Changes in vital signs recorded and charted as structured data 80% 5 Smoking status recorded as structured data for patients ≥13 years 80% 6 Clinical decision support used to improve performance on high-priority health conditions Yes 7 Patients given the ability to view, download, and transmit their health information within 4 days of its availability to the provider 50%, 5% 8 Patients given clinical visit summaries within 1 business day of a visit 50% 9 Electronic health information protected by appropriate technology Yes 10 Clinical laboratory test results recorded as structured data 55% 11 Condition-specific patient lists generated Yes 12 Clinically relevant information used to identify patients who should receive reminders for preventive or follow-up care 10% 13 Appropriate, patient-specific education resources identified 10% 14 Medication reconciliation performed 50% 15 Transition of care summary provided for each transition of care 50%,10% 16 Ongoing submission of electronic immunization data to immunization registries Yes 17 Secure electronic messaging used to communicate with patients concerning relevant health information 5% Menu measures (providers must meet 3 of 6) 1 Ongoing submission of syndromic surveillance data to public health agencies Yes 2 Electronic progress notes entered into patient records 30% 3 Imaging results are accessible through certified electronic health record technology 10% 4 Patient family health histories recorded as structured data 20% 5 Ongoing submission ofcancer case information to a public health central cancer registry Ongoing 6 Ongoing submission of specific case information to a specialized registry Ongoing
Additional Files
The Article in Brief
Sustaining "Meaningful Use" of Health Information Technology in Low-Resource Practices
Lee A. Green , and colleagues
Background Implementation of electronic health records (EHRs) has been studied extensively, but less is known about maintenance of EHRs once implemented. This study explores potential barriers to maintaining meaningful use of EHRs in primary care practices with limited financial, technical, and organizational resources. (Under "meaningful use," medical practices must show that they use certified EHR technology in ways that can be measured in quality and quantity.)
What This Study Found Primary care practices with limited financial, technical and organizational resources, especially those in rural areas, are at high risk for falling on the wrong side of a "digital divide," as payers and regulators enact increasing expectations for EHR use and information management. Maintaining EHR technology will require ongoing expert technical support indefinitely, beyond implementation, to address upgrades and security needs. Maintaining meaningful use of quality improvement will require ongoing support for leadership and change management. This is a particular challenge for rural practices, because expertise is often not available locally.
Implications
- Without long-term support solutions, the many challenges of maintaining health information technology will likely overwhelm low-resource practices.
- The operational and financial consequences of falling behind in EHR maintenance could mean lower quality of care for patients or possibly no care at all.
