Healthcare providers have discovered that identifying the technologies to perform some meaningful use measures is not as easy as federal rules might suggest.

Providers have to wrestle with what supporting technologies are needed to become meaningful users of electronic health records to quality for incentive payments, according to some physicians who have shared their experiences. They also need to determine what information tools in addition to EHRs should be certified, because they are involved in documenting meaningful use. [For more on barriers to implementation, see [Blog: The top 10 barriers to EHR implementation].

Physicians told of these technical challenges and how they expect a higher bar for their information systems in Stage 2 of the meaningful use process at a Jan. 19 conference sponsored by eHealth Initiative, an organization which promotes the adoption of health IT.

The standards and certification rule established by the Office of the National Coordinator for Health IT describes the functions and features that EHRs must be capable of performing to fulfill meaningful use requirements. But that doesn't cover everything.

For example, Christus Health has about 700 software applications in use throughout its system. Although they are not all necessary to accomplish meaningful use, the provider still has to figure out what software requires certification, said Hank Fanberg, technology advocate for Christus Health.
 

The main vendor supplies a certified and complete EHR system, but "they don't have everything we need," he said.

"You have to deconstruct the meaningful use criteria to figure out what to do and what software and what programs are needed," Fanberg said, adding that there are multiple ways to achieve meaningful use criteria.

"We are having this dialogue with vendors about what needs to be certified, depending upon the application that we think we need to use and making sure that it is certified," he said.

Some providers were adopted health IT many years ago but may need to modernize their EHRs to keep up with more complex functions in later stages of meaningful use, said Dr. Harry Laws, chief medical information officer and clinical professor at Indiana School of Medicine.

"We've been digitized for 13 years (and) we know we can get to stage one with our old system," he said. "But we'll need the newer system for stage 2. We're just figuring out what system to purchase."
 
Later stages of meaningful use are expected to call for more extensive exchange of health information. Since Indiana is a multi-campus university health system, that will demand that "we institute a culture change for standardization in the way EHRs are adopted and used," he said.

Despite the efforts that change will demand, "the fact that the government has put stakes in the ground means we have to get started," he said.

Providers can leave the money on the table and not participate in the EHR incentive program, but they'll have to do it eventually because "that's where healthcare is going," Laws said.