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Interoperability platform necessary to realize full benefit of meaningful use
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While adopting widespread use of interoperable electronic medical records may provide better care through improved collection and sharing of key patient health care information, an inclusive platform to support this interoperability continues to be a key missing element in meaningful use.
“The government created this process and yet they are responsible for the biggest missing link,”
Despite his frustration, Kraupa believes in the end goal of meaningful use (MU). Health care will greatly benefit from being able to electronically prescribe, electronically exchange health information among providers and institutions, educate and engage patients in their own care, and establish quality clinical measures to improve care, Kraupa said.
Gregory Kraupa
“Once the government provides us with a good health Information technology platform that allows this electronic exchange, MU will create a fuller and more accurate patient history,” he said. “It can greatly improve quality of care, reduce errors and reduce duplication of services, which will ultimately reduce health care cost.
“Without the interoperability component, the value of the MU process is still there but probably doesn’t justify the cost to the provider or to government agencies creating standards and oversight,” he said.
Improved care
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“Because MU covers many areas of clinical care, some of which may not be normally provided by optometry – blood pressure measurement, for example – we have been able to do things like identify a significant number of patients who have out-of-control hypertension. A few of these have led to hospitalization or urgent care treatment to reduce their blood pressure to possibly prevent TIA [**spell out**] or stroke,” Henry said.
Jay W. Henry
Henry also touched on a number of MU objectives that optometrists should already be fulfilling, such as maintaining an active medication list or active allergy list.
“I suppose you could say that MU is really the check to make sure we are truly doing these things on every patient,” he said.
Even for doctors who provide good care, MU can help them improve, he said.
Kraupa, for example, said, “The MU process currently helps me provide better care through electronic prescribing, through expanded clinical standards, by the electronic health record prompting us when we may have overlooked a test or procedure associated with a quality improvement program. It prompts us to provide information to the patient in print or email format rather than just verbalizing it during an exam summary.”
There are, however, some challenges with MU, more than the absence of an interoperability platform.
Choosing an EHR
Initially, the most significant challenge doctors incorporating MU will face is finding an electronic health record company that provides the software, training and support to make MU possible, according to Kraupa.
“In my opinion, there are companies that do a good job, but none that do a stellar job,” he said.
Henry encouraged doctors to demo the product and be sure they like how the information goes in to the EHR and how it looks once the data is in there. “Don’t just look at the current encounter; be sure to test how easy it is to see previous results, such as past refractions, past anterior segment results and so on. Can you adapt to the workflows that the EHR utilizes?”
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Progress should be evaluated daily at first, then perhaps weekly. However, constantly evaluating progress is critical to MU success, and corrective action will need to be taken if any of the reports indicate an objective is not being met, he said.
“It’s also important to understand that with the new changes to MU that have been released, you will be in stage 1 for the first 2 years of participation,” Gross said. “You will move to the newer stage 2 rules and objectives after the first 2 years.”
Also, registration for the EHR incentive program should be done as early as possible in the year clinicians plan to participate so there is ample time to address any problems before the attesting deadline in February of the following calendar year, according to Henry.
Implementation
The next challenge is to get the staff and doctors into the practice of using the EHRs and utilizing the full benefit of the MU capabilities.
“For those who have done this, you know how challenging this can be; however, it is well worth it in the end,” Kraupa said.
Gross agreed: “The history-taking and data-gathering required to meet all of the MU objectives, along with completing the needed clinical documentation, requires significant time. This will certainly make doctors feel less productive.”
But this is just a matter of adaptation, he said.
“Offices will need to change their workflow and adjust to a steep learning curve so you can gather the proper data for MU in an efficient manner,” Gross said. “For us, after doing this for 1 year, it is certainly not as traumatic executing it as it was when we first started out; we are now up to full speed and production.”
Philip J. Gross
“Record keeping,” Henry said, “is likely to be more thorough once you address all the MU objectives. You certainly need to make sure you understand your certified EHR and how it calculates the numerators and denominators for each objective. You want to be sure that you are putting the structured data into the correct fields where your EHR is looking for that specific data so you get credit for each objective.”
MU does not require special codes, so there is no effect on coding; “however, you need to run consistent MU compliance reports to make sure you are meeting each of the MU objectives,” he said.
“Meeting MU standards does add some time and additional record keeping responsibilities, and while some of the standards add value, some seem to be bureaucratic red tape,” Kraupa said. “However, I think over time the good parts of the system will remain in place and the inefficient parts will be discarded.
“That’s the optimist in me speaking, though,” he added. – by Daniel R. Morgan
For more information:
- Philip J. Gross, OD, can be reached at the Vision Quest Eye Care Center, 820 Walker Rd, Dover, DE 19904; pgross@vqeyecare.com.
- Jay W. Henry, OD, MS, can be reached at Hermann & Henry Eyecare, 650 Hill Road N., Pickerington, OH 43147; jhenry@hheyecare.com.
- Gregory Kraupa, OD, a Primary Care Optometry News Editorial Board member, can be reached at Eye Care Centers, 1965 11th Ave. East, Suite 101, Maplewood, MN 55109; (651) 777-3555; greg.kraupa@comcast.net.