Implement drug formulary checks, access to at least one formulary. More EHR adopters responded that they did not use this function than those who reported using it. A few participants noted its usefulness, but more noted the difficulty of using the function when their patient population was covered by many different insurers, not all of whom made a formulary available through an EHR. Others noted that the formularies within their EHRs did not always contain accurate information, so they did not trust them to guide their decisionmaking in prescribing drugs, or that the formularies took too long to load in their system to be useful. Several participants noted the use of alternative tools, such as Epocrates, outside of their EHR.
When it works it’s helpful.
That’s an add-on for our software as well. We have not purchased it and…from what they tell us, when you put in all the formularies you might serve, the software slows down so much that you might be waiting in the prescribing segment of your chart for a minute or two while it loads all these formularies. So we haven’t purchased that add-on yet. For the most part we all use Epocrates.
Drug formulary—it is ironic that we have the ability to do this, but we click no, because it takes too long to watch the system check. It takes a minute but it seems like forever so we just blow right past it.
Incorporate lab test results into EHRs as structured data. As reported above, the most frequently reported electronic interface that EHR adopters had was with laboratories. Some participants who had this functionality reported the usefulness in receiving laboratory results more quickly, or being able to make the results available to patients through an online patient portal. However, many providers noted the expense of creating those interfaces so that laboratory results could be incorporated into EHRs as structured data. Although they would like an
electronic interface, they would still need to enter information from paper or scanned records in order to put results in a structured format.
Well, I think it makes it easier, and it shortens the waiting time, because we can get the lab results in 2 or 3 days whereas before it could take 5 to 7 days for us to get the results.
If it would pull data into the system automatically, that would be lovely. We have the same difficulty right now. If I send a patient out to [lab vendor], I may or may not get a piece of paper back from [lab vendor] saying whatever that lab result is. And I have no way to import that electronically into the system so it’s available to us, it just becomes part of the paper record. So right now, if I want that, it gets scanned and then added to the encounter, but it’s cumbersome and ugly.
Basically in our system I can do pretty much all the structured data that’s listed except for the last one, which is lab test results. The reason, of course, is that we’re not directly linked to our labs. Whether it’s in the hospital or not, we send out the request diagnostics because it’s too expensive to try to have an interface with each entity. So basically we’re getting results faxed in and then we scan them into the EMR system. If I want to put in the results of the labs as structured data, it is going to create a lot more work.
Generate lists of patients by specific conditions. Many more EHR adopters reported the that they could generate lists of patients by specific conditions, than those who said their EHR could not. Several participants cited specific examples of how they used this function. One tracked patients with asthma, diabetes, or BMI over the 90th percentile. Another example was to query the EHR on specific diagnoses or age ranges. A third example was using this function to be able to report on how often specific care was provided to a patient population.
Participants in several focus groups noted challenges with using this function. For example, a few participants noted that it was difficult to get information they had entered into the EHR generated from the EHR in report formats. Others noted that they used the billing system, not the EHR, to generate these lists for quality improvement.
Identify patient-specific education resources from EHR. By a slight margin, more EHR adopters said that they used their EHR to identify patient-specific education resources than those who said they did not use their EHR this way. Only one participant reported satisfaction with their EHR’s functionality. Others highlighted challenges to using this function, such as not finding information on a sufficient number of topics, or information in the right language to use with the patient. An additional concern was the cost associated with subscribing to a service that provided high-quality patient education resources. Many more participants indicated that they provided patient-specific education resources, but went to the following sources to find the appropriate information:
Barriers to Meaningful Use in Medicaid
3-37 • Google™
• FamilyDoctor.org (information in both English and Spanish) • Other unspecified Web sites
• American Academy of Pediatrics fact sheets • Brochure from pharmaceutical company
Medication reconciliation performed at transition of care. Participants who used EHRs were about evenly divided between those who performed medication reconciliation and those who did not. Only one participant said that this function was not a problem, and that she was able to do this when a patient transferred from a hospital or nursing home. Participants more
frequently reported that any medication reconciliation they do is manual, not automatic because information they receive from other providers is mostly paper-based. Several participants noted that they weren’t sure what they needed to do to meet the Stage 1 MU objective, even though one said she received an alert from her EHR prompting her to do this.
Summary of care record for patient transitions or referrals. Slightly more EHR adopters reported being able to produce a summary of care record from their EHR than those reporting they could not do it. One participant noted that the benefit was that the records were legible and neatly typed. Several participants were unsure of the requirements for this Stage 1 MU objective and whether or not their EHR could meet those requirements.
Test ability to submit immunization or syndromic surveillance data to registries or public health agencies. Many more EHR adopters reported that they did not use their EHR for public health reporting than those who said they could use their EHR this way, with a small number of people indicating they were unsure of their system’s capabilities. None of the participants recognized the ability of their public health agency to receive, or their EHR to submit, syndromic surveillance data. More EHR adopters spoke positively about their State’s immunization registry, whether or not they could electronically upload data from their EHR to the immunization registry.
Some nonadopters said they would like to use this function, while others believed that EHRs did not yet have this capability and were skeptical that it would become available in the near term.
They can access immunization information. Actually, at midnight our immunization documentation gets uploaded to the State registry. We have an interface with them, which makes reporting easier.
The [State] Department of Health doesn’t have the bidirectional interface set up yet. That’s the only reason I’m not able to use it through my EMR.
Send reminders for preventive or followup care (patients 65 or older or 5 years or younger). More EHR adopters reported that they did not use their EHR to send reminders than those who reported that they did. Participants most frequently commented that they send reminders manually (not from their EHR) because their EHR is “clunky” in the way it sends reminders. One participant noted that patients were reluctant to share email addresses that would facilitate these types of reminders generated from the EHR.
A lot of patients—they are saying, on the HIPAA [form], not to contact me by e-mail…in terms of the way that I can communicate to them and communicate their information. Some are saying I don’t want e-mail. I don’t want fax.
I don’t think my program has any way to do that, and I have not come upon a good system to do that automatically.
Provide patients with timely electronic access to their health information. Many more EHR adopters reported that they did not have the ability to provide patients with online access to their health information via a patient portal or PHR. Among those that did have a way of
providing patients with online access to their health information, several participants noted that this feature was beneficial to both providers and patients.
However, participants (most of whom did not currently have a patient portal) also reported concerns with setting up online access to health information for their patients, including—
• Cost
• Concern about confidentiality and security of information • Language barriers
Patients are very happy with it. We try to teach patients that the portal is there for them to look at that information and help us to make any corrections, any errors they find. It has been very well accepted by the patients and they actually love the portal.
Patient access to their own records online—no, we don’t have a patient portal yet but we want one. It’s probably like a million dollars to set it up for our system. So it’s very expensive to do that.
We have patients that still don’t speak English, mostly the mothers who I’m dealing with. Their husbands may speak English, but the mothers don’t. And I just don’t seem to them logging into the patient portal, and filling out forms in advance, and checking on their own lab results. So I think the [State Medicaid] clientele that I’m working with are not going to be using it.
There are all the issues—for the patient portal I mentioned, you have to get a password and you have to give an ID. When they go home, they usually have problem accessing so they have to call the office and change their passwords and change the ID. It’s a headache.