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How is the progress of your primary care evolution?
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Optometry is evolving in era of health care reform. Depending on your mode of practice, your future will depend on your direct involvement with primary medical care.
Private practice will not be sustainable by just providing the traditional routine eye exam and glasses or contact lenses. This type of care is moving to the vertically integrated delivery models of eye care.
Primary medical care will be the key to the survival of private practice. Moving to this mode of practice and developing the relationship with primary care physicians (PCPs), Patient-Centered Medical Homes and coordinated care delivery systems is an evolution that will take many years. However, there are several steps that we can all take to move the process along.
The first step is to devote more time and attention to the aspects of the eye examination that are primary medical care. These points are the Review of Systems, Medical Reconciliation, the patient’s family history and the inclusion of the results of this information combined with the results of the actual examination in the final summary, overall health risk analysis and ongoing management plan.
This is fairly simple when there are obvious eye-related problems such as a visually significant cataract in a young diabetic or a branch vein occlusion in a patient with longstanding hypertension. For many optometrists however, the discussion of these medical conditions in a patient with good vision and no related eye findings seems outside of our comfort zone.
I have even heard comments such as, “If the eyes are not affected, systemic medical problems are outside the scope of optometry.” In this era of health care reform and the shift to prevention and wellness, this type of discussion and the related patient education is the exact role for the optometrist. For young patients with refractive errors, the optometrist is often their only contact with the health care system.
The second step is to record this health care information in a meaningful way so that it is available for follow-up care and can be updated and used for ongoing patient care. The only effective way to accomplish this is with an electronic health record (EHR). Now, to many followers of this blog, this may seem like a contradiction, as I have been a critic of all of the current EHR systems used in optometry. Although I may disagree with some of the specifics and am often frustrated by the transition, I fully support the concept and am confident that the systems will evolve to meet our needs.
In addition, EHRs are critical in our evolution to primary medical care. Optometrists need to choose an EHR system that meets the needs of their practice and begin the transition.
Of significant note, most of the points that I mentioned in step one are things that I learned in my transition to EHR and will make the evolution to a primary medical care mindset more comfortable. All of the EHR systems have needed to address this on the road to meaningful use. In the world of health care reform, “meaningful” is related to the primary medical care agenda and is not related to ophthalmic information.
The final step is related to transferring the primary medical care data on each patient into the health care delivery system so that it will be meaningful for any other health care provider that is caring for that patient. By the same token, updates in this basic health information need to get back you so that your EHR is updated and that you can be aware of what is happening to your patient between your visits. This is the step where optometrists actually enter the arena as members of the health care team.
This is the most difficult step and one that will take a significant commitment of time and capital to make these connections in a safe and secure manner to assure accurate and reliable transmissions while maintaining HIPAA compliance. It will also be a foreign concept to the traditional medical community to be involved with exchanging meaningful primary medical data with optometry. In spite of our significant gains in medical education and scope of practice, many in the medical community still consider us merchants of glasses and contact lenses. This means that this issue will be politically charged and will require the medical community to adjust to our expanded role.
I have expressed my concern about the meaningful use of our EHRs getting too far ahead of this third step and negatively affecting the broad acceptance of the EHR movement for optometry. Yet I have been encouraged over the last several months by some practical movement along these lines with several players emerging with practical solutions to close the information loop.
Because the broad acceptance of optometry in the role of a primary medical care provider by our complex society will take time, it is critical that all of us start down the path as indicated by steps one and two. Do not wait for step three to be fully implemented and operational to begin your evolution.
Start now by helping all your patients understand your need for their full medical history and your role in educating and counseling them about their overall health. Start now by improving your communication with your patients’ PCPs. Start with your diabetic patients by faxing a comprehensive report to their PCP on their ophthalmic status. Follow up with reports on other chronic medical problems.
The role of a primary medical care provider will not be handed to the profession of optometry just because the idea makes sense on paper. We have recently seen how other logical ideas in health care do not roll out as designed. If optometry wants to evolve in this direction, the majority of practicing optometrists must pursue this venture with steps such as the ones outlined above.