Practice Management Tip

Ten Key Things to Know about Meaningful Use

By: Cheyenne Brinson, MBA, CPA

Say the words “Meaningful Use” to most surgeons and the response is usually a sigh, a groan, a mumble or a head shake.  As a consultant who has been helping surgical practices implement Meaningful Use since its inception, I most often have to debunk myths surrounding the program.  With all due respect to the EHR vendors, many of them are trained to present Meaningful Use to the masses (i.e. all specialties).  Surgeons often find themselves as the square peg in the round hole and are led to believe that they have to perform tasks to meet the objectives that are not clinically relevant.  

Ten key things surgeons need to know about Meaningful Use:

1. Reporting.  Each physician will report for a minimum of two years under Stage 1 criteria before moving to Stage 2.  The physician will report two years under Stage 2 criteria before moving to Stage 3.  The criteria changes between each of the stages so it’s important to stay abreast of the changes.  
2. Clinical Quality Measures (CQM).  CQMs are absolutely the most misunderstood aspect of Meaningful Use.  Meaningful Use does not require surgeons to perform quality measures that are not clinically relevant to their specialty!   There are no minimum values for reporting CQMs and you are not penalized for reporting zero values. In fact, the Federal Register states “our policy on allowing ‘‘zero denominators’’ to be reported allows specialists to meet the CQM reporting requirements of meaningful use and is a continuation of our policy from the Stage 1 final rule.”  So what does that mean?  Simply put, choose the requisite number of CQMs to report (based on your stage) but you don’t have to perform them (if they are not clinically relevant)!   There are 64 CQMs and very few are applicable to surgeons, depending on your specialty.   
3. Vital Signs.  Meaningful Use does not require surgeons to take vital signs of height, weight and blood pressure.  In fact, there are exclusions for physicians who attest either height and weight and/or blood pressure have no relevance to their scope of practice.  Further, the threshold for this objective rests with unique patients, not each visit.  We have seen practices interpret this measure to mean that height, weight and blood pressure are to be obtained at each visit.  They were performing unnecessary steps as the measure looks at these vitals only once per patient during the reporting period.  From a practical standpoint, many surgeons obtain vitals for new patients and then as clinically necessary.  
4. Smoking status.  It is not necessary under Meaningful Use to record adult smoking status during each visit.  Rather, the measure is based on unique patients.    Record smoking status at least once during the reporting period.  Again, it is a great question to ask new patients and again as clinically necessary.
5. Clinical decision support interventions.  Stage 1 requires physicians to implement one clinical decision support intervention and Stage 2 requires five.  Forget Meaningful Use for a moment.  What would be a helpful alert from the EHR as you practice medicine?  One surgeon stated that knowing if the patient had a family history of malignant hyperthermia would be critical as he would take that patient to the hospital for surgery rather than the ambulatory surgery center.  The objective states they are to be evidence based decision support interventions based on the each one and at least one combination of the following data:  (A) Problem list; (B) Medication list; (C) Medication allergy list; (D) Demographics; (E) Laboratory tests and values/results; and (F) Vital signs.   Work with your EHR vendor to set these up.  
6. Patient Portal.  A patient portal is a must for Stage 2.  The benefits are far reaching from Meaningful Use requirements and can help patient flow (patients completing their health history in advance of the appointment!)  The tricky part of Stage 2 is the requirement that 5% of unique patients seen during the reporting period view, download or transmit to a third party their health information.  The onus is on the practice to “sell” the benefits of the patient portal to its patients to achieve the 5% threshold.  There is another requirement under Stage 2 to use secure electronic messaging to communicate with patients on relevant health information.  For those practices in rural areas, there are exclusions available if your area does not have 3Mbps broadband available.  
7. Clinical Summaries.  First, let’s clarify that surgeons are not expected to provide a copy of their note to the patient or complete the note prior to the patient checking out.  There are 20 specific required elements of a clinical summary – the ones that need physician attention are clinical instructions and the care plan including goals and instructions.  The requirement under Stage 2 is that the instructions are provided to the patient within one business day.  From a practical standpoint, it is advisable to print the clinical summary when the patient checks out.  A clinical summary done properly can help reduce the amount of return phone calls from patients asking “now what did the doctor tell me to do?”
8. Protect electronic health information.  This is an often overlooked component of Meaningful Use as it’s typically not something the EHR vendor provides for you.  The biggest part of this requirement is to conduct or review a privacy risk analysis of the technology.  This usually requires an outside vendor but there are free do-it-yourself tools available at  The objective also addresses the encryption/security of data stored in the EHR as well as HIPAA policies and procedures.  
9. Patient care reminders.  Recently, I learned of a neurosurgery practice sending out reminders for colonoscopies (not exactly clinically relevant!)  The Federal Register states “an eligible provider should use clinically relevant information stored within the [EHR] to identify patients who should receive reminders…. The EP is best positioned to decide which information is clinically relevant for this purpose.”  Clinically relevant examples would include a reminder for an outside referral, a follow-up on a MRI or other test, or a reminder to schedule a post-operative appointment.  
10. No more progress notes as a scanned attachment.  With Stage 2, at least 30% of unique patients must have a minimum of one text-searchable electronic progress note created, edited and signed in the EHR.

The good news is that when Meaningful Use is paired down and focused on what surgeons “really” need to know, then Meaningful Use becomes doable, attainable and not nearly a headache that many believe it to be.  
KarenZupko and Associates offers a 30 minute webinar on Stage 2 Meaningful Use for Surgeons for $49.  The webinar can be viewed at:  under Products/ Webinars / 2013 Crash Course in Stage 2 Meaningful Use for Surgeons

Cheyenne Brinson, MBA, CPA is a practice management consultant and speaker with Chicago-based KarenZupko and Associates.  She has been teaching and advising surgical practices on Meaningful Use since the program inception.  Cheyenne can be reached at 312-642-5616