It's estimated that fewer than 7% of providers in the small physician practice (1-10 physicians) have adopted and are successfully demonstrating use of electronic health record system.

The reasons vary from cost to fears and myths about the “inefficiencies”, and concerns that “the government still hasn't told us what the standards are.”

Doctors and other eligible health care providers who meet the federal government's meaningful use criteria could earn up to $44,000 or $63,000 each in incentives depending on the patients (Medicare or Medicaid) they treat. Demonstrating meaningful will be complicated at best. The real problem is who is going to be the “EHR coordinator” in the small practice setting? Whether small practices realize it or not it is nearly a full time job to ensure that a practice is successfully using the various components of the EHR efficiently. The problem is directly tied to the financial model of the EHR vendors. They are in the software business not the service business. Demonstrating meaningful use of an EHR is most definitely a service. Some vendors such as HIELEX of Tampa, FL and WorkSmart MD of Daytona Beach, FL are taking a unique approach and offer EHR support and meaningful use services.

Despite the Regional Extension Centers being a government initiative the program has some potential. Since the REC's funding is directly tied to meaningful use, and each vendor they select must work to demonstrate meaningful use, there is a better chance that those providers the REC assists will better utilize an electronic system.

The current model most EHR companies is taking is reason for real concern. Even with their “Stimulus Guarantees” they are in it for the quick pay day then on to the next provider.

Meaningful use criteria will come into effect in three incremental stages. Stage one starts in 2011, followed by stage two in 2013, and stage three in 2015. Health care providers have until end of 2014 to achieve any of the stages, but the more stages they achieve before 2015 the bigger the payout in meaningful use bonuses they'll get. (By 2015, penalties will begin kicking in for non-compliance.)

“Many healthcare providers are still trying to figure it out,” in terms of the basics, like picking out the software and other technology they'll need in their practices, let alone the workflow and other issues they'll also need to tackle, said Zywiak, who is also a co-author of the new CSC report, Meaningful Use For Eligible Providers: The Top Ten Challenges.”

With so few healthcare providers on track right now for stage-one compliance, there will also be a scramble for health IT talent to help implement these systems, said Zywiak. The government's HITECH program crea

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ting dozens of “regional extension centers” across the country to help assist doctor practices and hospitals should help some, “at least that's the plan,” he said.

In the meantime, CSC has pinpointed the top challenges eligible health care providers face in meeting stage-one meaningful use requirements:

1. Capture the data–that includes collecting and entering data in a structured formats so that data can be sorted and selected for reporting purposes, said Zwiak.

2. Establish effective workflows to reinforce data entry, including medication reconciliation. For instance, “often, an organization's workflow needs to be modified to make sure data is entered,” while patients are being cared for, whether it's vital signs like blood pressure or allergy updates, said Zywiak.

3. Drive provider involvement in adoption of the EHR. “The primary users of these systems need a say” in what's selected, said Zwiak.

4. Computer-based provider order entry (CPOE). “In ambulatory settings, 80% of orders, including tests, referrals and medication prescriptions, will need to be entered electronically,” he said.

5. Start e-prescribing. “Do this as soon as possible,” he said.

6. Develop a process for managing clinical decision support. This could include different clinical reminders for individual doctors in the same multi-specialty practice. For instance, a primary care doctor might need different alerts than a dermatologist caring for the same diabetic patient.

7. Implement patient health information exchange workflows. As a healthcare provider, “you've got to provide patients access with information–but will you do this via a patient portal or through a [third party] personal-health record” site, such as Google Health, said Zwiak.

8. Formulate a provider health information exchange strategy. “How will you exchange patient summary data with hospitals, specialists?,” he said.

9. Ensure privacy and security compliance. “Most primary care organizations haven't been on an EHR, so they think of HIPAA in terms of protecting paper-based information,” he said.

10. Initiate EHR-based quality performance measurement support. “You'll need to report quality measures to Medicare and Medicaid,” he said.

There are many factors that can ensure an EMR is properly used. Our organization has helped dozens of physicians to install various EMR software systems. The installs that we have seen as successful always have key stakeholders on board, outstanding training, and full customization. Then ongoing support. The ongoing support is key.

So, is meaningful use possible in the small provider office? Well, anything is possible. It's definitely more complicated and there are more issues at play than anyone realizes. With the right planning and training it can be done but these small providers will need more support than anyone realizes.