Over the last year, the EHR landscape has shifted so frequently that clinicians have struggled to keep up-to-date on the most recent changes to the guidelines for meaningful use. The final guidelines from CMS relieved some of dermatologists' initial worries that the standard for meaningful use would be too cumbersome, but some legitimate concerns remained about the impact the new guidelines might have on the everyday operations of a medical practice.

The start of the new year saw the beginning of the incentive qualifying period get underway in the first of several stages that will unfold in coming months and years. Given the number of EHR programs available in dermatology alone, the daily struggles of physicians attempting to qualify for incentive dollars may vary based on individual circumstances. Nevertheless, regardless of the system being used, participating physicians' understanding and implementation of the new guidelines are likely to change as they adjust them in real-time.

Previous articles in this department have addressed and analyzed individual components of the meaningful use standards. Ahead, I will recount some aspects of the guidelines—particularly in the realm of e-prescribing—where clinicians will likely need to turn their attention in coming months.

New Realities of E-Prescribing
In my initial experiences with meaningful use, the most significant change has undoubtedly been the writing and recording of prescriptions. Most EHR software will keep track of which prescriptions are prescribed electronically, versus those that are printed for the patient and those that are faxed directly to the pharmacy. However, it is important to note that only those that are e-prescribed are included in the total percentage of e-prescriptions required (40 percent) to qualify for incentives. That means some programs will not allow you to both prescribe electronically and print a copy for the patient. And even though faxing a prescription to the pharmacy involves electronic communication, it will not be included in that bottom line number of e-prescriptions.

Meeting a minimum of 40 percent of all prescriptions handled electronically may prove difficult for some clinicians. The shear number of potential scenarios for how a prescription is made and transferred can lead to confusion on this point in the guidelines. Several years from now, when more computer and EHR systems are likely to be linked among pharmacies, practices, and hospitals, meeting the e-prescribing standard may be much easier. But right now it can be an area of uncertainty and/or frustration, particularly since a fair number of patients desire a printed prescription to take to the pharmacy. Therefore, depending on the system you use, it is very important to ensure that you meet the minimum requirement and strategize methods for implementing e-prescribing in your office. In addition, if you haven't already purchased an EHR, make sure that the vendor you select offers software that will keep track of your number, including percentages of e-prescriptions. If you already have an EHR but are uncertain as to whether it tallies these percentages, it may be wise to contact the vendor and request a software update.

Another reason why e-prescribing is a critical matter in the broader scheme of meaningful use is that you will not likely be able to manually change e-prescription information as you can other information in your system, such as demographic information and lab work. The number of e-prescriptions written is entered into your system and cannot be changed. Given the explicit number of 40 percent of all prescriptionrequired to be e-prescribed, handling thismatter with care right at the outset is crucial.

Tips On the Go
While e-prescribing is likely to be a focal point formost clinicians engaged in meaningful use, otheraspects of EHR implementation are worth considering:

Acquire extra demographic information. If youintend to qualify for government incentives, you willneed to make sure that three pieces of informationare dutifully and consistently recorded: the patient'slanguage, race/ethnicity, and smoking status, if thepatient is over the age of 13. Acquiring this informationmay not be the additional burden some clinicianswere fearing, since you should cover much ofthis information when recording a history of previousmedication, allergies, etc.

Acquire extra demographic information. If youintend to qualify for government incentives, you willneed to make sure that three pieces of informationare dutifully and consistently recorded: the patient'slanguage, race/ethnicity, and smoking status, if thepatient is over the age of 13. Acquiring this informationmay not be the additional burden some clinicianswere fearing, since you should cover much ofthis information when recording a history of previousmedication, allergies, etc.

Maintain an Active Problem List. The importance ofthis area will range depending on the system you use.Nevertheless, some programs may not automaticallymark every diagnosis as a “problem.” The guidelinesrequire that a problem list be kept, so most softwareshould offer a simple manner of achieving this.

Provide a Summary for Each Patient. The new guidelinesalso stipulate that a patient summary must beavailable if the patient wants to view it. And whilemost systems offer some kind of patient portal, it mustbe activated in order for patients to have access to theirindividual summaries. Some systems require patientsto have a username and password, which can be achallenge for your staff. If it is, you may be able to simplyprint a summary for every patient, whether or notthey receive it.

A Measure For the Future
Clinicians can experience any number of issues duringthe first stage of the meaningful use incentive periodrollout. Some may experience far fewer than othersdepending how EHR-ready their practices are or whatsystems they use. As physicians work through whatmay likely be a challenging 90 days in order to qualifyfor incentives, their feedback will provide an earlymeasure for how the remaining stages of incentivequalifying may play out.