A use case for eye care

We mentioned last day that EMRlogic had presented at the ONC's Direct Demonstration Showcase in Washington, DC. Why was our use case selected? First, because it met the requirements of a closed-loop referral involving the primary care physician (PCP), a specialist provider (ECP) and a patient (PHR). Second, our use case was unique and interesting. We designed it to demonstrate the value independent eye care providers can bring to team-based healthcare. Here are the essential points of the use case:

• 28 yr old patient presents at rural optometry practice (ECP) for routine exam. Patient reports blurred vision. Problem list from CCD indicates gestational diabetes. 
• Patient reports one year since routine post-partum visit. ECP alerted via software's Clinical Decision Support (CDS) that best practice standard not met. Patient referred back to PCP for follow-up. 
• PCP orders routine lab tests. 
• PCP office receives lab results via Direct into EHR inbox. Office manager reviews and assigns to PCP and attaches lab results to the patient medical record. 
• PCP forwards lab results to patient’s PHR using Direct. 
• PCP notifies patient via Direct message to contact office for follow-up visit.

This use case is just one example of why independent eye care providers, many of them beyond the geographical reach of large health systems, are so important to the healthcare system we want and need. 


Notice that the patient did not go to the doctor because she felt she was sick. She went, in fact, feeling healthy. The signs and symptoms of her gestational diabetes were gone. Breast-feeding over, hormones back to normal, she went to her eye doctor simply to have her prescription renewed. It is the eye doctor seeing the "healthy" patient who has a unique opportunity to return the patient to her family physician for needed follow-up and preventive care.


In the same way that the software's CDS can alert the eye care provider to the need for follow-up care, it can equally well advise him or her of the ocular side effects of prescribed medications. (See a clear example on our web site's home page.) In team-based healthcare, other physicians will look to ECPs to provide this insight. None of us can know this for every drug ... but software can. That's one thing computers do exceedingly well. 


Back to the basics: 

• EHRs are more helpful than paper charts. 
• The use of EHRs is not an end in itself.
• You must move beyond EHRs to the exchange of health information.
• Sharing and communications are cornerstones of team-based coordinated care.
• Team-based delivery implies team-based reimbursement.
• You cannot get paid if you cannot or do not participate in care teams.
• You must prove both ability and value before you will be accepted onto care teams.

Alistair Jackson, M.Ed.
Jim Grue, O.D.