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Blog: The practicality of meaningful use
Along with many of my colleagues, our practice moved to electronic medical records in 2011. This allowed us to take advantage of the stimulus package offered by the government to those of us willing to be early adaptors.
We did not realize how disruptive this technology would be, and although the stimulus covered the raw cost of the conversion, it did not cover the reduced patient volume and the wear and tear on the staff and doctors alike. The extra time required with each patient to complete the chart and the amount of time that doctors sits in front of the patient with their nose on the screen while stumbling though the typing of volumes of free text is difficult to measure.
That said, things had been improving, and we all made the adjustment. It was our sense that although we had issues, we were providing more comprehensive care and had better documentation. In addition, we felt that the technology would improve, and that the long term result would be positive. The senior members of our group see most of the Medicare patients and we, therefore, followed up with the attestation for stage one meaningful use.
As we adapted to our electronic records, we found many areas of the software that were inefficient and redundant and led to consistency errors within the chart. We had developed some “workarounds” and were able to upload external documents to fill the gaps. With this in mind, we were eager to see the next software upgrade and were hopeful that some of these issues would be resolved.
Our latest update was released about 2 weeks ago, and we were stunned to find that rather than improvements in efficiencies, the program is completely bogged down with ICD-10 and changes for stage two meaningful use. Of course we now know that all the work related to ICD-10 is offline (see last blog), and the changes related to stage two have added more time and work that are not relative to the current practice of optometry. I have long been an advocate of optometry moving more in the direction of primary care and I truly believe that these changes will be a part of our long-range future. However to spend 10 more minutes on the primary medical care work-up with no ability to transfer that information to the primary care database and with no delivery care models on the horizon that will utilize the data, it seems that we are “putting the cart before the horse.”
I don’t fault my electronic health record (EHR) company. They have generated a long and tearful response to the tidal wave of criticism they received after the release of their latest version. They are responding to pressures of their industry and attempting to be sure that optometry continues to comply with the mandated changes.
In my opinion, the lesson of ICD-10 should be applied to stage two meaningful use. Providers, in general, and optometrists, in particular, have really struggled, first, with the implementation of EHR and, second, in using the new charts to the level of stage one meaningful use. The front loading of the stimulus to the initial change and to stage one has left very little incentive to implement the disruptive changes to comply with stage two, and I shudder to even think about stage three. The health care delivery system needs to catch up to the capabilities of EHR to make these changes truly meaningful.
The evolution of optometry from primary eye care to primary health care is important, and I continue to support this movement. The changes, however, need to be logical and practical. Forced changes that violate these principles cause too many practitioners to abandon the changes and revert to traditional practice patterns. Optometrists need to follow these changes and voice their concerns to the American Optometric Association, our lobbying voice, and to participate in the dialogue in public forums such as the blogs here at Primary Care Optometry News.