Demonstrating Meaningful Use
Now that we have dealt with the formalities it is time to roll up your sleeves and begin the heavy lifting. Where should you start? First and foremost identify someone within the practice who will become your meaningful use champion. Even if you elect to seek outside assistance, someone in the practice will need to develop more than just a passing familiarity with the program. The framework is complex, non‐intuitive in certain places and full of nuance. Find your champion and put them to work understanding the framework. Next make sure your entire practice is on board. There is enough work here to go around and it is almost impossible for the nephrologist to succeed alone. Engage the ancillary staff within your practice early. You will be glad that you did.

The first place your champion may wish to start is with the menu (table 2). It is important to identify the measures on the menu that make the most sense for your practice. If more than one physician in the practice is planning to demonstrate meaningful use, I highly recommend everyone select the same five objectives from the menu. This strategy may prevent mutiny within your practice. The measures you select will depend on both internal work‐flow as well as the scope of your practice. As you consider the objectives on the menu, pay close attention to the four objectives without a threshold. Do these apply to your practice? Are you taking the Medicaid path and if so has your state made it more challenging to report immunizations and syndromic surveillance? As you look at the six measures with a threshold, recognize you will be compelled to select at least one of these. How well does your EHR handle laboratory data? Do you see many patients in follow up after a hospital discharge? Do you frequently hand out educational information to your patients? Carefully consider what you do today and make your selections accordingly. Your goal should be to minimize changing the work flow within your practice.

After you have tackled the menu objectives, review the requirements for each of the ten core objectives with a threshold (table 1). Understanding the requirements is the first step towards optimizing the integration of the meaningful use framework within your practice work flow. Who enters demographic data for your patients? Who captures vital signs? Who will print the clinical summary? There are a finite number of fundamental questions. Once you have the answers you are ready to roll out the plan for success. Perhaps your receptionist is responsible for capturing the five required demographic fields (date of birth, gender, race, ethnicity and preferred language) and he or she is responsible for printing the clinical summary after every office encounter. If you are using a patient portal to address several patient facing objectives, perhaps your receptionist is also responsible for issuing log in credentials to your patients.