Ophthalmologists anticipate final stage 2 meaningful use criteria for EHRs

Eye physicians want new performance measures to be phased in gradually, include imaging standards and focus more on specialties, less on primary care.

Issue: September 10, 2012

Ophthalmologists have concerns about performance measures included in stage 2 meaningful use criteria for electronic health record implementation.

The Centers for Medicare and Medicaid Services released a proposed rule on the criteria in February and accepted comments from concerned stakeholders until May 7. A final rule is expected to be released later this year.

Electronic health record (EHR) adopters must meet staged meaningful use criteria to qualify for Medicare incentive payments of up to $44,000. Incentive payments are reduced for providers who adopt later.

The deadline for meeting stage 2 meaningful use criteria was extended 1 year. Physicians and hospitals adopting EHRs in 2011 or 2012 are not required to meet stage 2 criteria until 2014.

However, new performance measures will be difficult for many physicians to attain, according to Michael X. Repka, MD, American Academy of Ophthalmology medical director for governmental affairs.

“There’s a lot more to implement, and I think it’s going to take a little time to do it,” Repka said. “Though I think that ophthalmologists can attain that level, to do it in one step is not reasonable, and doing it perhaps with some interim steps or relaxing the percentages would be helpful.”

Performance measures

Michael X. Repka

Repka said that many ophthalmologists disagree with a requirement that all physicians collect data on vital signs at every office visit. However, CMS relaxed that benchmark and made it optional, he said.

We want to see ophthalmologists exempt from vital signs if they feel it’s not within the scope of their practice,” Repka said.

Ophthalmologists also disagree with a requirement that demographic data be included in the EHRs of more than 80% of unique patients, Repka said.

“Patients may consider some of it questionably relevant to ophthalmic care. An 80% threshold just seems high. [But we] expect that we’ll do it in many cases, and that should be fine to demonstrate compliance,” he said.

The AAO suggested that the stage 2 criteria require such data to be stored in the EHRs of 60% to 65% of unique patients rather than the proposed 80%, Repka said. Stage 1 criteria required that demographic data be included in the EHRs of 50% of unique patients.

Interoperability, specialty focus

Repka voiced concern that stage 1 meaningful use criteria did not include imaging standards that would help EHRs communicate with each other and their imaging hardware. The inclusion of Digital Imaging and Communications in Medicine (DICOM) standards would enhance EHR interoperability, Repka said.

“We asked for interoperability,” he said. “We asked for better imaging standards, how to make sure that you can see the images in the EHR product. … If the DICOM standard was made part of the rule, that would solve the problem. … That would be terrific.”

(Two teams of ophthalmologists recently completed DICOM standards for ophthalmic thickness mapping storage and transmission.)

Additionally, the stage 2 criteria are geared too heavily toward primary care, Repka said.

“We’d love to see a little more involvement of specialty care or at least getting this product more aligned to the nature of a specialty care practice,” he said. – by Matt Hasson

References:

Health IT. Meaningful use stage 2 notice of proposed rule-making. http://www.healthit.gov/policy-researchers-implementers/meaningful-use-stage-2-proposed-rule.
U.S. Department of Health and Human Services. Medicare and Medicaid programs; Electronic health record incentive program—Stage 2. 42 CFR §412, 413 and 495. http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf. Published March 7, 2012

For more information:

Michael X. Repka, MD, can be reached at American Academy of Ophthalmology, 20 F Street NW, Suite 400, Washington, DC 20001; 202-737-6662; email: mrepka@jhmi.edu.
Disclosure: Repka has no relevant financial disclosures.