The 7 deadly sins of meaningful use -- and how to avoid them


Since 2002, electronic health record (EHR) adoption among physicians has more than tripled, climbing from 17 percent to 57 percent in 2011. Yet, a large number of physicians with certified EHRs are still failing to attest to meeting Stage 1 meaningful use to collect their incentive dollars from the Centers for Medicare & Medicaid Systems (CMS). In fact, many physicians are choosing not to attest altogether. Why the hold up?

Despite efforts to educate the medical community, there’s still a lot of confusion around the process of attestation, which has earned meaningful use a reputation for being complex and daunting to pursue. The reality, however, is that the meaningful use incentive is not that difficult to attain — so long as physicians know the pitfalls to avoid.

As part of my role at Amazing Charts, I’ve personally coached countless physicians through the process of attestation to help them collect their EHR incentive payments. Based on this experience, below are the seven most common — and avoidable — pitfalls I’ve seen physicians encounter on the road to meaningful use. With a solid understanding of these pitfalls, you have already successfully started your meaningful use journey.

1. Misunderstanding the exclusions. Meaningful use is broken down into 15 core criteria and 10 menu items. All 15 core criteria are required, while you get to choose five out of the 10 menu items to pursue. Often, providers analyze the required core criteria and when they see one or more that they cannot meet, they turn their backs on meaningful use altogether. This is where the exclusions come into play.

Six out of the 15 core criteria are eligible for exclusions. For example, there is Core 8, record vitals for more than 50 percent of patients two years and older. This criterion can be intimidating for providers who do not take vitals during patient encounters. Luckily, there is an exclusion for this criterion. The exclusion is as follows: An eligible provider who sees no patients two years and older or who believes that all three vitals of height, weight and blood pressure have no relevance to their scope of practice can be excluded from this measure.  Without the knowledge of these meaningful use exclusions you may have given up all too soon.

2) Not using codified medications. Whether you are e-prescribing or updating a patient’s current medication list, it is essential to choose codified medications. This is because there are two core criteria that require codified medications, Core 1: CPOE and Core 4: E-Prescribing. Without using codified medications you will be at risk for failing these two criteria. Look for an EHR that comes with a pre-loaded medication database, which makes choosing a codified medication for updating and e-prescribing an easy and efficient process.

3) Hiring someone to complete the risk analysis.  It is a common misconception that you must hire an IT person or pay a local Regional Extension Center to conduct the risk analysis required by meaningful use.  You likely don't need a security consultant to identify the security holes in your office. Most people know where the holes are. If you don't, a template can specify some scenarios that may refresh your memory regarding certain security weaknesses. One such template is the Office of the National Coordinator's Risk Analysis Tool.

4) Difficulty understanding the Clinical Quality Measures (CQMs). To get the EHR incentive, you must become accustomed to CQMs.  Often, they are difficult to understand and even more difficult to conquer.  A good EHR should be able to help you fully understand each CQM, including each CQM’s description, rationale, clinical recommendation and most importantly, the steps of how to complete the CQM from within the EHR.

5) Not running your meaningful use report often enough. It is very important to stay on top of your meaningful use numbers. You do not want your percentages to drop without your awareness. Set one day each week to run and analyze your meaningful use report. Catch the percentages that are dropping and fix the situation before you find that a specific criterion is holding you back from attestation.

6) Being frightened by Menu 9: The Immunization Registry.  For practitioners, this can seem like a real challenge but it is actually a fairly simple task.  Some states require you to upload your immunization file to the state registry in order to meet the Menu 9 criterion. Other states are not yet requiring practitioners to upload the file to a state registry. Your EHR can make this process simple if you are able to export your immunization file in an HL7 format. If your state requires you to upload the immunization file, you can upload the HL7 file directly to your state registry without any issue using your EHR. If your state does not require you to upload the file, then just exporting the file from within your EHR should give you credit for meeting the Menu 9 criterion.

7) Not understanding what to do with your completed results. After you’ve spent all this time collecting meaningful use information, what do you do with your results?  When your reporting period has ended you will need to submit your results to your state’s CMS. This process is known as “attesting.” You will first need to register for the meaningful use incentive program. Be sure to contact your certified EHR vendor to get their meaningful use certification number. When you are ready to attest, go to this link and log in.

The attestation process is very easy from there. CMS will provide you with an electronic form that asks you to enter your numerator and denominator for each criterion, and if it is an attestation criterion, it will ask you if you are attesting.  An EHR such as Amazing Charts will include all of the information you will need to attest to CMS. Simply print out your report prior to attesting and enter those results to CMS.

If you collect Medicare or Medicaid, you are likely eligible for EHR incentives that can add up to thousands of dollars per year.  Don’t be intimidated by meaningful use. If you can successfully navigate the seven pitfalls of meaningful use, you will get there quickly and painlessly.

Katie Vacca is a product support specialist and meaningful use expert at Amazing Charts, a developer of EHRs.  As part of her role, Katie works with Amazing Charts clients to help them achieve meaningful use and collect their EHR incentive checks.