The Nitty-Gritty of Meaningful Use – Part 1

To this point I have contemplating Meaningful Use from 10,000 feet above the landscape.  I have done my reading, been to meetings, and met with our EMR vendor…all the usual things.  But this week it was time to roll up our sleeves and go down from 10,000 feet to cut through the jungle at ground level and bring MU to our practice of 19 physicians.

We faced the maddening task of reviewing 15 Core Set Measures and choosing 5 out of 10 Menu Set Measures, and then getting them done.  I have to admit that some parts of meaningful use are not too bad.  But there are other parts that are confusing, redundant or totally ridiculous.

Regarding the first 6 of the 15 Core Measures:

CPOE for Medication orders.   The concept is fine but the requirement is not structured well.  It reads, “More the 30% of all unique patients with at least one medication in their medication list seen by the EP (eligible provider) have at least one medication entered using CPOE.”  Read it carefully.  It says if a patient walks in my door and reports to be on any medication, I have to prescribe another medication whether the patient needs one or not.  Most doctors write enough prescriptions that by luck of the draw this won’t be a problem.  But we have 2 docs that don’t write a lot of prescriptions and they are currently don’t meet this measure even though they rarely, if ever, write a paper prescription.

Drug-Drug interactions and Drug-Allergy Interactions.  No problems here.

Maintaining a Structured Problem List.  Certified EMRs do this automatically and this function is essential to quality measurement and outcomes research.  Some of us (me included) need to change our documentation habits to get the proper data capture.   By personal habit I prefer writing unstructured paragraphs instead of distilling a patient visit down to a bunch of ICD-9 codes.  I’ll get over it.

 E-Prescribing.  Obviously an appropriate requirement.  But it sets the bar higher than the CPOE for Meds requirement (see #1 above), so why bother having the CPOE requirement at all?

 Maintain structured active medication and allergy lists.  Also a reasonable requirement.  This has always been a part of the physician’s visit routine.  The only problem is that the EMR requires the doc to check a box for each of these requirements.  I am going to try to modify our existing templates to make that task as painless as possible.


In future installments on this topic I will cover how we are handing the remainder of the MU requirements.  Stay tuned.