Meaningful Use: Not Just for EHRs.

In the January 2012 edition of Optometric Management, Dr. Walter West wrote an article entitled, "Meaningful Use: It's not Just for Electronic Health Records". His essential question is whether or not providers are fee-focused or patient-focused in their use of diagnostic equipment. It's the easiest thing in the world, after acquiring a new piece of expensive equipment, to find suddenly that a lot more patients are suspects for the disease your new instrument is designed to screen. Dr. West issues a challenge to review your clinical protocols and ensure that your use of diagnostic equipment truly improves the quality, safety and efficiency of patient care.


I wholeheartedly agree, yet want to take this notion a step further: health care reform is designed to eliminate unnecessary testing. Let's understand that significant cost overruns in health care are attributable to tests being done multiple times at multiple facilities. The reason may not just be poor judgement or an ulterior motive on the part of a doctor. The patient may want a second opinion and go to another hospital, for example. Hospital A cannot access the records at hospital B so cannot offer simply another review of the original tests; the tests are duplicated. Same result. Same diagnosis. Double the cost. It happens all the time, sometimes at a cost to Medicare of $20,000 or more per instance.


Now granted, eye care has not primarily caused this problem. However, it must be fixed across the board. At the heart of the issue are two things: a lack of portability of patient health information; a fee-for-service reimbursement system that cannot differentiate between excellent care, mediocre, poor or fraudulent care. The answer? EHRs and a pay-for-performance model. 


Long story short, as we move into Stages 2 and 3 of EHR certification, health care reform will root out sub-optimal practices, whatever the cause. Exams will be submitted every time for electronic audit, and reimbursement will be contingent upon achieving best results. Billions of dollars are being spent on the transformation of healthcare in order to lower costs, raise quality and improve patient outcomes. Each provider has a part to play in achieving those very same goals.


Alistair L. Jackson, M.Ed.