I showed the dashboard and the core principles to John Glaser (then at Partners HealthCare) while we were both speaking at a conference in Victoria, British Columbia. A few years later, when John went to the Office of the National Coordinator to support David Blumenthal, John took the influence of those core principles and dashboard with him. I'm not exactly sure what role the dashboard and those principles played in seeding the federal meaningful use program, but I suspect they had some degree of influence. By the way, we (Northwestern) offered to give the code and dashboard to the EMR vendors so that all clients could benefit, but the vendors declined. We shared them instead on the users groups' websites.

Below are the simple but effective Core Principles of EMR Utilization that we developed. These principles played a huge part in the progressive value of Cerner and Epic on the Northwestern campus and laid the foundation for a relatively easy qualification of Northwestern under the federal meaningful use program.

Core Principles of EMR Utilization

Encounters

• All patient appointments/visits are to be documented in the EHR as an encounter.

• Visit encounters should be closed by the attending physician within 48 hours of the patient visit.

Medications

• All medication prescriptions and refills must be documented in the EHR, including those ordered in a telephone encounter.

• Medications are to be reviewed at every patient encounter, in accordance with the individual specialty's standard of care.

• Every effort should be made to maintain a valid and complete list of patients' current medications in the EHR, including end dates, discontinuing medications no longer being taken, and removing duplicate medication entries.

Problem lists

• All chronic, persistent patient diagnoses or complaints should be documented on the problem list in the EHR, with the exception of highly sensitive diagnoses such as those associated with mental health care.

• Problems should be documented using the most specific term applicable to the problem, ex: mild intermittent asthma vs. asthma.

• The problem list should be reviewed and updated at every patient encounter, in accordance with the individual specialty's standard of care, and problems not currently clinically relevant should be filed to history and marked as resolved.