EHRs, technology upgrade or culture change? (Part 2)

Picking up from Friday's post, I promised a discussion of point #6, "Choose for the long haul not today's feature list". 

As a former educator and having been involved now for many years in both sales and marketing of eye care software, I understand something of the learning curve. Then there's also the drive to market and sell a product. As a business owner, you want and need a solution that will go the distance, hopefully 10 to 20 years. Selling a product can easily be all about today - today's hot features, bells, whistles and so on. The two don't mesh and, unfortunately, most consumers are superficial in their selection process, even the ones who try to pull off a big comparative analysis and extensive due diligence. 


May I offer my considered opinion? Selecting the right EHR for eye care over the next decade or two is inextricably linked to understanding the culture change required not only in your practice but in your profession and across healthcare. Optometry, by and large, has never had true medical software solutions. Health care reform is changing all that. You now need not only a robust medical eye care EHR but also a connected-care EHR. You don't need just software that's great in your office but software that's also great for your role in at least one local ACO and the state HIE. That's a whole different ball game.


If you're thinking about EHRs for your practice, your focus is too narrow. Think outside the box. Think community and beyond! For every hour you spend evaluating software, spend an hour researching how healthcare in your community is changing. Find out about your local ACOs. Learn about getting into a patient-centered medical home and onto a chronic care team. Then find EHRs that can step up and help you communicate (patient health information) with those new colleagues and referral providers. That's the name of the new game.


Finally, don't assume that any or every certified EHR will fit the bill. Not so. Check out this quote from yesterday's media. Bold mine. Read the full article here.

"Of nearly 4,000 physicians responding to the survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, 51 percent said they intended to apply for the incentive payments. Only 11 percent, however, had an EHR system installed that would have met 10 out of 15 requirements for the Stage 1's core objectives."

Despite certification, it's still a buyer-beware market. EHRs certification has created a new level playing field. The field is on a higher plane, yes, but there are still winners and losers. Understanding your health care reform world is, more than ever, the key to choosing well for the long haul. And if you're an ECP, we're all about the help and guidance you need to win.


Alistair Jackson, M.Ed.

EHRs, technology upgrade or culture change? (Part 1)

The question of moving from paper charts to EHRs is by now a rather old one. Whether or not you've done it, you've at least considered it. A colleague recently shared with me a worthwhile read about selecting and implementing EHRs in small ambulatory practice settings. That setting fits for most optometry and many ophthalmology practices. See the full report here. 


One of the primary takeaways is that implementing EHRs is a culture change in the practice and requires a definitive change management strategy. As we sometimes say in our work, "You're not plugging in a new TV." 

EHR implementation means both benefits and barriers but you only get to the benefits once you've overcome the barriers. Yes, there are many technical aspects to the transition but if it were just technology, it would be simply plug 'n play like a new TV. TVs don't require change management planning and execution; EHRs do. Particularly in today's transforming healthcare environment, implementing change is complex and entails a steep learning curve at the people level.

So what do we mean by change management? Notice how these steps are essentially non-technical:

1. Start with a vision for the benefits to be gained.
2. Understand the impact on current workflows. What will this culture change really look like in your practice?
3. Anticipate the barriers. Prepare the team to absorb shocks.
4. Choose a champion, someone with pull not push, a leader whom staff and doctors will follow. (This doesn't have to be a doctor, or the doctor.)
5. Create buy-in during the selection process. Involve all stakeholders. A "complete EHR" will get into everyone's business.
6. Choose for the long haul not today's feature list.
7. Work with your vendor to create a clear project plan. Good vendors should be able to help you a lot here. We do this stuff every day whereas you do it once in a blue moon.
8. Prepare thoroughly and implement rapidly.

You've seen such lists before - and the linked article above goes into much greater detail. I'd like to comment on point #6, "Choose for the long haul not today's feature list". Herein lies one of my personal passions. We'll need to make this discussion, Part 2. 

Alistair Jackson, M.Ed.

Looking "outside", seeing the road ahead

Our December 19, 2011 post was entitled, "To understand eye care, look outside!" We talked about the infamous crystal ball, which no one seems to have, and why it's not actually needed if we simply look outside eye care ... at the hospitals. If we follow hospital news, we'll see the road ahead for eye care, really for the domains of care of all independent practitioners.


Today's look at Becker's Hospital Review reveals yet another new healthcare model: the integrated care model, or network. Two have been announced in the last week, one in Central Georgia and the other in Western New York. Let's look at the one in New York since it involves a BCBS partnership. The bolded words are mine, for emphasis.

"BlueCross BlueShield of Western New York and Kaleida Health of Buffalo, N.Y., announced plans to partner and form an integrated care model, the first of its kind in the Buffalo region.

The model includes a network of Western New York physicians partnering with health system Kaleida and health insurer BCBS to create a physician-led organization. It's a first of its kind healthcare delivery model for the Buffalo region in that it combines a health plan, health system and group of physicians providing patient-centered care.

It's essentially a commercial accountable care organization. Kaleida Health refers to it as a "strategic partnership" intended to "assure accountability for both the clinical outcomes of the patients and the costs of the care delivery model."

Are we drifting off into aspects of health care reform that don't apply to ECPs? Absolutely not. Admittedly, we still feel the need to point to the evidence that says (a) health care is transforming, and (b) the very changes we're seeing today in the hospitals are the changes we'll see in your practice tomorrow. If we're harping on HIEs and ACOs, it's because these entities matter for you. This is not about stimulus money, neither grants nor penalties. It's about the survival of your business.


Action items for ECPs:

1. Find out about your state HIE and how you can get connected to it.
2. Inquire about local ACOs and what it takes to belong to a care team.
3. Ask your software vendor about their readiness to offer you ONC Direct. (We have written a number of posts recently on HISPs and ONC Direct. See those for more details.)
4. At the bottom of this post, see "Comments and Reactions". If you have a question, click on that title and type away. We'll be more than happy to respond.

Alistair Jackson, M.Ed.



  

Health systems didn't learn to share in kindergarten!

In kindergarten, you learned it's important to share, right? It's obvious that hospitals and big health systems didn't go to kindergarten ... at least, not one where sharing was a core value. What do I mean?

I'm really referring to patient health information, CCDs in particular. By definition, the CCD is a standardized Continuity of Care Document that contains key patient health information. It's intended to be shared with the patient and amongst health care providers. (Strictly speaking the CCR - Continuity of Care Record - is a slightly different version meant to be shared among providers.) Stage 1 meaningful use stipulated that EHRs be capable of sending and receiving the CCD, at least in a humanly readable format.


As we look into the Stage 2 certification criteria, it's clear we'll be moving beyond this "humanly readable" baseline. And rightly so. Humanly readable is what we call "viewable but not usable". In other words, sending patient health information as a PDF is not really sharing. Unfortunately, this is the still the de facto standard among the hospitals and ambulatory care health systems.


Why is this important? Think of it this way. If one of your referral providers sent you a patient summary of care, would you prefer to receive it as a PDF attachment in your email or electronically such that it automatically updated your EHR? Pretty obvious, right? The first way is the old way, a method on the way out from U.S. healthcare. This applies equally to pseudo-electronic transmissions such as fax and even web portals that let you download a PDF. The second way is the new way, a means already in use by some EHRs, and the standard to which all certified EHR technology will need to measure up in Stage 2.


Same question, different answer: why is this important? We know that the #1 fear among doctors about going to EHRs is that they'll produce a slowdown in the exam lane. More than any other single benefit, receiving the patient's problem list and history from other providers will speed you up. We estimate a 10-minute benefit per exam when the CCD is both sent and received electronically. We're also predicting better quality data than is typically obtained through a patient interview. If you're using e-prescribing, you've already experienced something similar, medication histories made available electronically in your exam record without having to enter that data yourself ... data that, in all likelihood, you never had access to before.


Our eye care audience should be interested to know that, at EMRlogic, we are now conducting tests with activEHR users to prove and measure the benefits of what I've described above. In terms of sharing PHI, we're already at Stage 2. Stay tuned. We'll be telling you more about the Pennsylvania HIE Eye Care Demonstration Project in the coming days, weeks and months.


Alistair Jackson, M.Ed.

ACOs, your new referral center

Accountable Care Organizations (ACOs), in the opinion of most national authorities, are the direction healthcare care delivery and reimbursement is going. It's important therefore that you understand the effect of this trend on your practice. There are two important points:

1.  Reimbursement. The way you will get paid for patients covered through an ACO will change. The ACO will receive a “bundled” payment for the care of the patient and the ACO will pay the providers delivering the care. You will no longer be able to bill the insurance company under a fee-for-service payment system.
2. Access. Your access to patients covered by the ACO will be affected.  A fundamental concept of the emerging health care delivery system is that outcomes for patients with chronic conditions is best delivered through teams of providers communicating closely about the patient, with the patient an integral part of the process, in order to determine the best management plan. Coordinating this team delivery of care is one of the main functions of the ACO. If you are not part of the team delivery system, you will likely lose access to these patients. As a part of the coordination of care, the ACO not the patient actually schedules the patient's routine appointments with team members.

The ACO also is responsible for ensuring that every provider who sees the patient has the appropriate patient medical information. (This is information shared among all team members.) The ACO, as part of its reimbursement, gets a specific fee for doing this coordination. This is why the ACO is becoming your new referral center.

There are three things you need to be doing before you'll be considered by an ACO to be part of a care team:

1. You must be using a certified EHR;
2. Your EHR must have the proper capabilities to communicate electronically with the ACO;
3. Most likely, you will need to demonstrate a changing culture in your practice, that you are embracing the implications of being an effective team member versus a standalone practitioner, as is now the dominant model.

Changing your practice to demonstrate the ability to be a productive team member is significant. Fortunately, there are now groups of eye care professionals collaborating to go through this process. We'll be sharing insights, on an ongoing basis, right here on EMRlogic Live. This is new territory for all. We hope you'll check back often and keep learning with us.

Jim Grue, O.D.

Are you too late for your local ACOs?

ACOs are popping up everywhere. Did you know? CMS is not the only organization driving them. In fact, the majority of ACOs in existence today are commercial ACOs not tied into CMS initiatives such as the Shared Savings Program. That says a couple of things:

1. That health care reform initiatives are growing beyond the bounds of Medicare. We all remember the days, I'm sure, when many protested, "Health care reform doesn't apply to me; I don't do enough Medicare to qualify for the stimulus funds."
2. That you can't follow only the CMS news for your region with regard to ACOs. You need to be following the hospital news as well. (See a good link below.)

Where does the rubber meet the road with ACOs? They're the organizations pulling health care providers into chronic care teams. Patient-centered medical homes are taking flight within ACOs. They're also the entities being reimbursed for team care and made responsible for provider payment.

But here's the real rub: if you're not already aware of the ACOs being organized in your area, not already talking to "the powers that be", you may have an uphill battle to be included. Get on this now. It's critical that eye care providers be involved in chronic care teams. I suppose the question is whether or not the ECP will always be a hospital-based ECP.

ACOs are taking over access to patients, including your patients. If you're not part of your local ACOs and their care teams, you will eventually struggle to retain your patients.

Below are two must-read articles on the topic of ACOs. See the CMS list of 27 ACOs and compare it against the other list of 80 ACOs. The lists show locations, so be sure to see which ones are in your back yard.

• CMS releases list of 27 ACOs
• 80 Accountable Care Organizations to Know

Also look here for that "hospital news" mentioned above. See especially the two articles (April 10 and April 12) on the Patient Centered Medical Home.

Alistair Jackson, M.Ed.

Reform at a glance

You may not have seen last week's April 10 press release from CMS entitled, "New Affordable Care Act program to improve care, control Medicare costs, off to a strong start ... Over 1.1 million beneficiaries now served by Accountable Care Organizations." I'm highlighting some excerpts not due to the message itself but because the press release touches on so many of Reform's key concepts. It's instructive to see them tied together and articulated for public consumption.

A new program that will help physicians, hospitals, and other health care providers work together to improve care for people with Medicare is off to a strong start, the Centers for Medicare & Medicaid Services (CMS) announced today.  

Under the new Medicare Shared Savings Program ... 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.

The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65 ... 

Anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.

Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July. 

To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.

To learn more about the ACOs announced on April 10, visit: http://www.cms.gov/apps/media/fact_sheets.asp

For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/.


As a reminder, care teams (to care for patients with chronic conditions) are being organized in Medical Home models, which fall under the umbrella of ACOs. ACOs, accountable care and shared savings are for eye care too.


Alistair Jackson, M.Ed.

HISP-HISP. What's that?

Last time, we introduced a relatively new acronym, the HISP or Health Information Service Provider. I mentioned that ONC Direct has become the official transmission protocol for protected health information (PHI) passed from one healthcare entity to another. ONC Direct will make use either of a single HISP or of two HISPs (a HISP-to-HISP exchange) if PHI is being shared between providers who use different networks. Let's understand that a little better.


Communications or "portability" of PHI began at the state level not the national level. Every state was funded through the HITECH Act to establish a Health Information Exchange (HIE) and quite a few are already operational. While there may be only one HIE per state, there will be many HISPs, several at least within each state. (Note that some of the operational HIEs today comprise largely hospitals and may have established central repositories of patient data, akin to a secure wide area network or intranet. Since communications were essentially internal to the system, those HIEs may not have been required to use a HISP.)


Large health systems, especially those involving ambulatory care for example, may set up a HISP. You should be aware that some may promote themselves as the only option in your state, especially if your practice falls within that health system's catchment area. This "promotion" may be somewhat covert or assumptive, of course, which is why you need to understand your options. HISPs developed by large health systems may be proprietary in nature and include portal or access fees. It's important to understand how the quest for control is working itself out in your state as health information becomes portable. If you're an independent eye care practitioner, you need to be careful about where and how you tie into your state HIE.


Your state will also be served by HISPs that do not face regional restrictions. Such HISPs are tied neither to large health systems nor to any particular state. It's probable that this type of "pure" HISP will serve the healthcare industry with more open technologies and advanced features and benefits. Remember that the HISP, by definition, handles only the secure transmission of healthcare data, sending and receiving. A good HISP will open doors not restrict or close them.


Interested in learning more about thought leadership around HISPs? Here's one worth checking out, one that's already at the forefront of connecting independent eye care providers to their state HIEs. Secure Exchange Solutions.


So what does HISP-HISP look like for you? Here's an example. Let's say you want to receive a CCD from a primary care physician or another hospital-based provider (because receiving the CCD will mean automatically populating your patient history, problem list, meds list and allergy list). That other provider is most likely tied into a different HISP network than you are, and maybe is part of that large health system. Your referral provider's CCD is sent on his or her system's HISP. Your receipt of that CCD are handled by your HISP. Therefore, one HISP sends, the other receives. That's a HISP-to-HISP communication. In due course, it'll become a daily reality, one that will shorten the length of your patient encounter, helping you see more patients in less time.


Alistair Jackson, M.Ed.

Acronyms of Change, Part 9 (HISP)

An acronym we haven't seen a lot of to date but of which we will learn much in 2012 is the HISP, or Health Information Service Provider. For some important background, let me refer you back to Part 4 of this Acronyms of Change series, since HISPs are surfacing predominantly in the discussion of ONC Direct (the Direct Project). ONC Direct has become the official transmission protocol for protected health information (PHI) passed from one healthcare entity to another. ONC Direct will make use either of a single HISP or of two HISPs (a HISP-to-HISP exchange) if PHI is being shared between providers who use different networks.

Before continuing, I'd like to contextualize the HISP discussion. Why is it important or relevant for you as an eye care provider? You may recall my earlier statement that 2011 was the year of the EHR and that 2012 would be the year of the HIE. HIEs are where you'll encounter HISPs. 

Remember, your state HIE is something you need to be learning about and seeking to get involved in now. So, assuming you have a certified EHR and may even have attested to Meaningful Use, you'll want to begin receiving patient CCDs from other providers. (Electronic delivery of this health information may save you up to 10 minutes per exam.) Sending and receiving CCDs is a big part of what the health care reform game is all about - this exemplifies both portability and interoperability. However, you can't simply call up other local providers and ask them to send over a CCD. That worked with fax and email but those communications methods are no longer acceptable. The CCD must be sent and received via encrypted protocols that assure the security of your patient's health information. (As noted above, the P in PHI stands for "protected", not personal or patient, although both those descriptors are also true and applicable.)

As you learn more about your state Health Information Exchange, you'll uncover a whole new network of  regulations and protocols akin to what we've all gone through thus far to achieve certification and meaningful use attestation. Since the HIE is all about exchanging health information, you'd expect - and indeed find - an approved encrypted transmission protocol. That's ONC Direct. And that's what HISPs must use. Correspondingly, you will need to enter into an agreement with a Health Information Service Provider in order to be part of your state HIE. (Not to fear, this agreement will be similar to the Business Associate Agreement that you're now familiar with. Your patients routinely sign your HIPAA statement of privacy practices and you do likewise with associated businesses, such as your software vendor, who may see your patient database. In fact, it'll probably be your software vendor who chooses your HISP on account of the connectivity required to enable the communications.)

Here's some reassurance about the security of your patients' protected health information. HISPs must observe the following "Trust and Privacy Considerations":

• The sender has assurance that the receiver is who the receiver purports to be
• The receiver has the same level of assurance in the sender
• Both have assurance that the content will not be modified in transit
• Exposure to personally identifiable information (PII) or protected health information (PHI) is under the complete control of sender and receiver

These preconditions are assured through the use of secure protocols in which messages are signed with the sender's private key and encrypted with the receiver's public key. Because of this:

• The sender ensures that only the intended receiver can view the content (through use of the receiver's private key to decrypt the data)
• The receiver ensures that the content is as was sent by the sender (through the use of the sender's signature)
• Both parties ensure that they trust the identity assurance and other certificate issuance policies of the sender and receiver's certification authority.

Last word. These acronyms and entities get admittedly dizzying. Our intent in exposing it all for you is not to heap up your responsibilities or add to your to-do list. Our hope is simply to bring some level of understanding and familiarity that let's you proceed well guided through the maze. 

Alistair Jackson, M.Ed.

More patients, less time, forever.

In a global sense, I'm an advocate of the transformation of health care. Of course, it's not all good and certainly not all easy. One of the sad pressures of our times is that doctors must see more patients in less time, and do that forever. We might blame that on health care reform but it's more likely an inescapable reality no matter what the system. A paper-based model demands the same but offers no hope for survival. We've all heard it said that insanity is repeating the same thing and expecting a different result. So, change we must.

I came across a blog post today (American Academy of Optometry - LinkedIn discussion group), entitled "See More Patients by Having Them Return Less Often. Huh?" In a nutshell, the discussion is about patient compliance, matching your recall efforts with patient patterns and expectations. You can recall your patient every year but if the numbers show they actually come back on average every 28 months, maybe you're wasting your marketing dollars. Maybe you'll see more patients return if you recall them closer to when they think it's time to see the eye doctor again.

Regardless of how you reconcile that difference - and I don't suppose there's just one answer for all - the fact is that the HITECH Act is driving all kinds of new technologies into health care, including patient communications. Consumer technology is driving some of this change on its own but health care reform is making it official, and that means everyone must play ball.

Good EHRs will take care of the "less time" issue by driving speed and efficiency in the patient visit. When it comes to educating your patients and improving compliance, you'll be assisted in whole new ways by the evolving technology of health care. Last week, for example, I learned from our e-prescribing partner (DrFirst/Rcopia) that we'll soon see a patient advisor module added to the mix, functionality that will include patient education, coupon offers and recalls, all able to be sent via email or text message. Does this type of service exist already? Of course it does, but as separate services. And how tired are we all of having multiple bills to pay, one here, one there, a seemingly endless array of third-party solutions. 

My point is that the transformation of health care is like the tide coming in. When the tide comes in, all ships rise. The bar is being raised all over healthcare and it's bringing hope, new possibilities, new integrations. It's by embracing the power of integrated technology solutions that we can hope to survive in a more-for-less-forever world.

Alistair Jackson, M.Ed.

The law of unintended consequences

Perhaps you remember when infant safety seats were mandated to be placed in the back seat of the car not in the front passenger seat. Made sense, right? So why did this action lead to a dramatic increase in child injuries from automobile accidents? The unintended consequence of the law was to cause parents to turn around while driving. Less attention to the road, more accidents.

The Affordable Care Act of 2010 is intended to bring about cost reductions on many levels in health care, and part of that is helping patients see clearly into cost and quality matters. The intended consequence of health care Transparency is to help consumers choose low-cost high-quality providers. But what if consumers believe more care is better and low cost means low quality? It's another great example of how our assumptions don't always lead where we expect them to go. 

Unintended consequences don't always mean the original thought was a bad idea. They remind us that change is more complicated than we anticipate, and the more so when many people are required to make changes. It's why public comment periods and the democratic process are so valuable in bringing about a better end game. I personally get impatient with the review process, the criticism, the debate but I have to admit it produces better results.

As we observe the transformation of healthcare over the coming years from fee-for-service to pay-for-performance and from disparate care to connected care, let's take the long view. Give yourself time and space to test assumptions and adapt, and do the same for those who are driving the bus. 

Alistair Jackson, M.Ed.
For some deep and interesting insight on this topic, see the article published on Health Affairs as "Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results" by Ateev Mehrotra, Peter S. Hussey, Arnold Milstein and Judith H. Hibbard.

EHRs - for the feds or for you?

Today, I'd like to add to a discussion of John's March 30 post at EMR and HIPAA, "Physician Reaction to Meaningful Use". The quoted physician is not alone in feeling that Meaningful Use has prevented EHRs from reaching their potential. Here's a sound byte to digest: meaningful use is for the government; meaningful usefulness is for you.

In the certification game, the big names rushed to be first. Though first to announce their success in achieving certification, they took months to roll it out to customers. Why? Because their doctors responded with comments like, "It may be certified but it's not usable." Thus began a new rush on development, the usability cycle.

In the eye care world, we had to remind ourselves and our users that MU has little to do with eye care, only insofar as we're part of the healthcare matrix. MU is not specialty specific. It's up to the vendor to ensure that the EHR meets the requirements of both government and doctors. Those are two different sets of needs. Now here's some good news. As the provisions of the HITECH Act continue to unfold, the gap between the government's needs and the doctor's needs will narrow. Let me explain.

Doctors in the process of adopting EHRs naturally think about their changing reality within the practice. How do EHRs change my workflow, my experience in the exam lane, my patient's experience within these four walls? Once the culture change in the practice has been embraced, it's not over. We're just more ready for the next step.

In 2012, we're through the first wave of EHR adoption and seeing Health Information Exchanges take center stage. That means we have to think outside our four walls and communicate with other providers like never before. The CCR and CCD, elements of all certified EHRs, will become an every day reality that not only transports the patient's problem list, medications, allergies and vital statistics between providers, it will also save providers minutes per exam. All these data will drop automatically into the exam record, significantly reducing manual data entry. Through state HIEs and other communication standards established by the HITECH Act, doctors will see benefits in EHRs that are not readily apparent today.

Circling back to the physician quote (“Meaningful use is the destructive component that all of medicine should be fighting as it clearly prevents the EMR from achieving its potential”), I have to say, "I understand but...!" It's a short-sighted comment by a doctor who isn't seeing the long range picture. Just as eye care providers cannot understand health care reform by looking only inside eye care, no one can understand health care reform by looking only at what's happening today. 

The transformation of healthcare is a journey with a sure destination. Many of us, not having looked at the roadmap, are simply along for the ride. A paper-based fee-for-service status quo was the true destructive force in health care. Meaningful use is a stepping stone to a brighter future, one that we'll be in a stronger position to appreciate once we're a little further down the road.

Alistair Jackson, M.Ed.

In the event you're new to EMRlogic Live, you should know that we like some other bloggers too. We focus on EHRs for eye care while others cover the broader picture. Two that we recommend are Jim Tate at HITECHAnswers and John at EMR and HIPAA.