Optometry - Journal of the American Optometric Association
Volume 81, Issue 5 , Pages 253-256, May 2010

Common questions regarding electronic health records

Article Outline

 

The AOA Health Information Technology and Telemedicine Committee answers some common questions posed by practicing optometrists regarding electronic health records.

Most optometrists use some form of the new digital technology that has come along over the past couple of decades (i.e., the Internet, cell phones, iPods). However, many optometrists may not yet be aware of all the ways digital technology is being adapted to advance health care. By now, most have heard the federal government has launched a major initiative to establish a digitized health information system in the United States. Yet, based on questions received over recent months by the AOA Health Information Technology and Telemedicine Committee (AOA-HITTC), many still have questions about how that will impact their practices.

The first thing any health care practitioner should understand about today's digital health information technology (HIT) is that it represents an important clinical tool with the potential to enhance patient care. Electronic health record (EHR) systems can provide practitioners with more complete and accurate patient information going into an examination. The electronic records and associated HIT functions can facilitate a more accurate and complete diagnosis, help avoid health care errors and adverse drug interactions, and improve compliance with care regimens through improved patient education. Combined with digital instrumentation and practice management software systems, EHRs can greatly enhance practice efficiency, leaving practitioners more time to devote to care. And, inclusion in the nation's emerging interactive health records system effectively strengthens the optometrist's position as an integral part of the health care team.

The AOA-HITTC has received comments from optometrists who have questions regarding what they will have to do to implement EHRs. Below, the committee has summarized some of the most common questions and answers on EHRs.

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Q: Why should I have EHRs in my practice? 

A: The federal government is establishing a new technical infrastructure—the Nationwide Health Information Network (NHIN)—to make personal EHRs available to all Americans. Practitioners will be able to access these patient records through network databanks (known as health information exchanges). In addition, the system will also provide functions that support clinical decision-making, patient education, and health data-gathering. The system could eventually provide the technical infrastructure for quality reporting and pay-for-performance programs as well as facilitate new care models such as “medical homes.” Many patients may soon come to expect their optometrists to have EHR access, in the same way practices are now expected to have a Web site or accept credit cards. Other health care providers and third-party payers will expect the same. As a result, practitioners who do not have EHR access will risk being shut out of the health care system. Government health plans have already begun offering payment bonuses for practitioners who use EHRs. They will soon be implementing payment penalties for those who do not. Private plans may do likewise. Special government EHR incentive programs are now also being offered.

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Q: What am I, as a health care practitioner, supposed to do? 

A: Basically, 2 things:

1.Install a certified EHR system in your practice

2.Use it, in line with specified utilization standards, to enhance patient care

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Q: When must I have an EHR system installed and in use? 

A: Ideally, it would be best to have an EHR system up and running by the beginning of 2011. That is when the government will begin offering incentive programs, which could cover the bulk of the cost of an EHR system. Practitioners will certainly want to have their EHR programs in place in time for the planned start-up of the Nationwide Health Information Network in 2014. Most optometrists will definitely want to have EHRs in place by the start of 2015 when Medicare plans to begin docking reimbursements for practitioners who do not have EHR systems.

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Q: What do I need to do this? 

A: Basically, a computer (either a PC or a MAC) with an operating system and a suite of security features (firewall, antivirus, antispyware, antimalware, and antiadware with automatic update mechanisms activated), broadband Internet access, a router (to contact the practice's various computers), and a certified EHR software program.

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Q: I have a practice software package already; will that be sufficient to serve as my EHR program? 

A: Probably not. The practice software in virtually all optometric offices will need to be upgraded. To be properly equipped, an optometrist must have a certified EHR program, meaning:

1.It is a true electronic health records program, which is distinct from a practice management system. An EHR provides all of the same information included in a paper patient record (i.e., chief complaint, patient history, prescriptions). Practice management programs generally include patient contact and insurance information and are used for nonclinical applications such as appointment scheduling, patient recalls, or claim filing. (A recent survey found that while around half of all AOA members have practice management systems, only about 1 in 5 have a true electronic medical records system in use.)

2.It has been certified to meet government standards that require the EHR program to provide:
•Interoperability with other health care records systems, so health information can be exchanged over the EHR network

•A designated list of required patient information, and

•Additional health information technology features such as the adverse drug interaction warnings and diagnostic assistance.


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Q: What should I do to bring my office software system up to requirements? 

A: If you currently have a practice management system, you will have to add a certified EHR system. If you have an EHR program, you will need to see if it can be upgraded to meet new federal standards. The easiest way to approach either task is to contact the company that produced your current office software system and ask if they will be making a certified EHR program that will meet federal (or Certification Commission for Health Information Technology) standards. If so, find out when it will be available and consider ordering one. If not, it may be time to go shopping for a software system. (A list of EHR vendors appears on the AOA Web site EHR page [www.aoa.org/EHR.xml].) Chances are a lot of health care practitioners are going to be looking for EHR systems in the coming weeks and months. Many practices that now rely primarily on paper record-keeping and claim-filing systems will be switching to computers. Moreover, many practitioners who have been using EHRs may find this an appropriate time to assess the adequacy of their current systems and consider updating. EHRs are about to become a very important part of day-to-day optometric practice and optometrists will need to have EHR systems that are well-suited to their practices.

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Q: How can I tell if an EHR system is certified? 

A: Look for Certification Commission for Health Information Technology (CCHIT) approval. The CCHIT is the only EHR certification agency currently recognized by the government.

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Q: About how many certified EHR software systems are currently available? 

A: At the current time, no optometric EHR programs have yet been formally certified. That is because the government only recently proposed its EHR certification standards. However, virtually all major optometric software houses are developing EHR programs designed to meet the government standards. As a result, certified optometric EHR programs are expected to be released to market in the coming months.

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Q: If no optometric EHR programs have yet been formally certified, how can a practitioner possibly go about selecting a system and readying a practice for EHR utilization? 

A: Optometrists should take the opportunity now to gather information, demos, and DVDs on as many office software systems as possible. Practitioners and staff should then take some time to evaluate which system will best suit the needs of their practice. After government certification standards are finalized, the practitioner can check with the manufacturer to ensure the system will meet government criteria. Remember, electronic health records systems are intended to enhance patient care and practice efficiency. By fact-finding now, an optometrist can have plenty of time to make an intelligent purchasing decision and select the EHR system that will best serve patients and the practice in the coming years.

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Q: What must I do with my certified EHR system, once I have it in place, to enhance patient care? 

A: The U.S. Department of Health & Humans Services has established a list of EHR utilization objectives (see Box 1). The objectives outline a range of EHR functions that can be used to enhance patient care. When a practitioner utilizes these functions for all (or at least a substantial portion of) the patients in a practice, the practitioner achieves what the HHS has termed meaningful use of EHRs. The department each year will stipulate how many times (or for what percentage of patients) practitioners must utilize each function to qualify for incentive programs, earn payment bonuses, or avoid payment penalties. Both the roster of functions and the target utilization rates are expected to increase each year.

Box.
HHS electronic health records “meaningful use” objectives for 2011

Improving quality, safety, efficiency, and reducing health disparities

•Drug-drug, drug-allergy, drug formulary check

•Up-to-date patient primary problem and active diagnoses (using ICD-9-CM or SNOMED CT®) (at least 1 entry or indication of no active problem) list maintained

•E-prescribing—permissible pharmaceutical prescriptions (those not prohibited under U.S. Food and Drug Administration regulations on controlled substances) generated and transmitted electronically with certified EHR technology

•Maintain active medication list

•Maintain active medication allergy list (at least 1 entry or “none”)

•Record demographics (preferred language, insurance type, gender, race, ethnicity, date of birth)

•Record and chart changes in vital signs (height/weight, blood pressure, body mass index, growth chart [children 2 to 20])

•Record smoking status (patients over age 13)

•Incorporate clinical laboratory test results into EHR

•Generate at least 1 list of patients with a specific condition (for use in quality improvement, reduction of disparities, and outreach)

•Report ambulatory quality measures to CMS (or state Medicaid agency)

•Reminders of preventive or follow-up care (patients age 50 or older)

•Clinical decision support rules relevant to practice

•Check insurance (public and private) eligibility electronically

•Submit claims to public and private insurance plans electronically

•Computerized physician order entry (CPOE)

Engaging patients and families in their health care
•Provide clinical summaries to patients for each office visit

•Offer patients electronic copies of their health information (within 48 hours)

•Provide patients timely (within 96 hours) access to their health information (lab results, problem list, medication list, allergies)

Improving care coordination
•Capability to exchange key clinical information (e.g., problem list, medication list, allergies, diagnostic test results)

•Perform medication reconciliation at relevant encounters and at each transition of care and referral

•Provide summary care record of each transition of care and referral

Improving population and public health
•Submit electronic data to an immunization registry

•Provide electronic syndromic surveillance data to public health agencies

•Conduct a Health Insurance Portability and Accountability Act (HIPAA) security risk analysis (or review past analysis)

Initially, practitioners will be required to install software, make sure the prescribed functions are operational, and use the system in the practice for as many office functions as possible (e.g., maintaining primary problem, medication and medication allergy lists). Practitioners are expected to use the systems in patient communications (appointment reminders, providing health information to patients), ordering health care products, prescribing pharmaceuticals, checking insurance information and filing claims, reporting health care data, and making interoperable patient records available to other health care providers. However, because the necessary technical infrastructure (such as health information exchanges) may not yet be in place in many parts of the country, the department may initially require practitioners to simply test some functions (such as health information sharing with other practitioners). Practitioners and their staff members should begin considering now how they will integrate the providing of these EHR functions into practice.

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Q: Is electronic pharmaceutical prescribing (e-prescribing) required for EHR utilization? 

A: Yes (see third meaningful use bullet point in Box). Moreover, this is an EHR function that an optometrist can—and should—implement immediately, as a first step in realizing the benefits of health information technology. Many practices already have e-Rx capability in their software systems. For additional information, see the AOA-HITTC Web page (www.aoa.org/HIT.xml).

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Q: Is participation in the Medicare Physician Quality Reporting Initiative (PQRI) required for EHR utilization? 

A: Yes (see eleventh meaningful use bullet point in Box). Virtually any practitioner can also implement this function immediately. Enhanced quality reporting is one of the main features driving the move toward EHRs. Practitioners will be required to use their EHRs to report PQRI measures to qualify for federal EHR incentive programs. After those programs expire, practitioners will still be able to earn PQRI credit for using EHRs. For additional information, see the AOA Web site PQRI page (www.aoa.org/pqri.xml).

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Q: What are the government EHR incentives? 

A: Under the American Recovery and Reinvestment Act (ARRA) HiTECH provisions, the Medicare fee-for-service program can provide health care practitioners up to a total of $48,400 in incentive payments over a 5-year period when they achieve meaningful use of certified EHRs. Medicare Advantage managed care plans and state Medicaid programs will offer similar incentives (subject to approval by the HHS). A separate Medicare e-Prescribing Incentive Program was authorized under the federal Medicare Improvement for Patients and Providers Act of 2008. It should be emphasized that practitioners can only participate in one of these incentive programs (Medicare, Medicare Advantage, Medicaid, Medicare e-Prescribing) at a time. It should also be emphasized that in many cases early adaptors of EHR technology will reap the greatest benefit from these programs. For additional information, see the AOA Web site EHR page (www.aoa.org/EHR.xml).

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Q: Is this really going to happen? 

A: Widespread utilization of EHRs may seem far-fetched now, but remember that electronic communication technology tends to be adopted very rapidly. (Just a few years ago, iPods, the Global Positioning System, voice-enabled street directions, YouTube, and social networking sites were virtually unheard of.) Reducing the cost and improving the quality of health care have become top priorities for both government and private industry. EHRs and related health information technology are central to virtually every major proposal to achieve those objectives. Proponents believe proper use of EHRs can help to reduce cost, eliminate health care errors, and ensure a high standard of care. Moreover, public health and defense officials view a national EHR network as critical to security against epidemics and bio-weapon attacks. Large-scale EHR systems have already proven effective in the military and U.S. Department of Veterans Affairs health systems.

It would be prudent for health care practitioners to work on the assumption that EHRs are coming and begin preparing their practices.

 This article was prepared by the AOA Health Information Technology and Telemedicine Committee as part of the AOA Electronic Health Records Preparedness Program for Optometry, which also includes the Enhancing Patient Care through the Implementation of EHRs continuing education course, supported by grants from Compulink Business Systems, EMRlogic Systems, Inc., Eyefinity/Officemate, First Insight, Marco, Practice Director, QuickEyes, RevolutionEHR, and Topcon. The course sponsors had no input in the development or outcome of this article. Opinions expressed are those of the authors and do not necessarily reflect the official position of the American Optometric Association.

PII: S1529-1839(10)00108-9

doi:10.1016/j.optm.2010.03.001

Optometry - Journal of the American Optometric Association
Volume 81, Issue 5 , Pages 253-256, May 2010

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