Quality improvement initiatives in provider organizations often go bad when they are mandated from the top down, and not integrated into clinical workflow and compete with other priorities, asserts Chris Wood, M.D., a family physician and medical director for information services at Intermountain Healthcare in Salt Lake City.

That’s why Wood worries that the HITECH Act’s incentive payments for meaningful EHR use will result in providers documenting meaningful use, but not really becoming meaningful users. For instance, one meaningful use criteria requires 80 percent of patients to have at least one problem on their problem list. Intermountain, which started building its EHR in 1968, currently has 1.7 million patients in its records database, with 58 percent having at least one problem on their list.

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