Allergies

• Allergy lists must be actively maintained for validity and completeness for all patients, including marking as reviewed when no new allergies are reported. The allergy list must be reviewed during any encounter in which a medication is ordered.

Orders

•  All patient orders must be documented in the EHR.

Progress notes

• All patient encounters should have an accompanied progress note that appropriately documents the history, physical, and decision-making in a way that is succinct and minimizes redundant content.

• If dictating, notes must include the patient's name and medical record number, the date of the encounter, and the attending physician's name to ensure timely documentation.

In basket

• Patient results and messages should be reviewed within 72 hours of receipt, and in-basket coverage should be assigned when clinicians are unable to respond within that time frame.

In the early days of EMRs, the pioneers like Intermountain Healthcare, Vanderbilt, Duke, and Partners differentiated themselves by developing their own proprietary EMRs and then using them in a meaningful way, without any financial incentive except their own to do so. 

Meaningful use Stage 1 served a valuable purpose – it jump-started the adoption of commercially supported EMRs in an industry that needed jump-starting. Maybe we should cancel Stage 2 and Stage 3, spend some of that money on seeds for true innovation (think DARPA for healthcare). And let survival of the fittest play a role in deciding which organizations will utilize their EMRs, and subsequent data, most effectively to improve healthcare.