Alistair Jackson, M.Ed.
Most questions about Electronic Health Records (EHRs) today still revolve around meaningful use and stimulus incentives. While meaningful use will remain a long-term concern, incentive funds will not.

While answers usually start with “it depends” followed by some questions, there are several concepts in EHRs that do not depend on you, your practice size, your technology preferences or your tech-savvy score.

A Culture Shift for Your Practice
The first big idea about the certification and meaningful use of EHRs is that they introduce permanent change, not a temporary program that merely coincides with the stimulus years. The change is also ubiquitous, across-the-board in health care. Health reform applies to everyone forever. This is particularly important for those who thought the stimulus incentives did not apply to them whether because they believed the program would fail and go away, or because they had insignificant Medicare volume to justify pursuing the grants, or simply because the changes seemed to represent too much effort. With or without the money, meaningful use of certified EHRs is required of all eligible professionals.

More than a technology shift, EHRs mean a culture shift for you and your entire staff. In fact, the shift required has been rather formalized under the patient-centered medical home model. The American Academy of Family Physicians has done the best job of formalizing this model through its subsidiary, TransforMED. Optometrists need to pay attention to this development in particular since primary care is moving into the limelight of care coordination. The culture shift required for eyecare means not only stepping up to the challenges inherent in team-based care but also including patients as stakeholders on the care team.

Stages of Certification
As daunting as meaningful use attestation may be, and the coming stages seem only to add to the complexity, there is a big picture. Seeing where we’re all going both inside and outside eyecare can be helpful. At the risk of over-simplifying, here are the three stages:

Stage 1: EHRs…information gathering

Stage 2: Beyond EHRs…information sharing

Stage 3: Value-driven health care…best practices and better patient outcomes.

Stage 1 introduced EHRs, now effectively a mandatory replacement for paper charts. EHRs were never intended as an end in themselves. Stage 2 brings the real purpose of EHRs, which is to facilitate information sharing and open the door to team-based, patient-centered and coordinated care. Creating the standards and infrastructure for this to happen is what Stage 2 is all about.

Stage 3 will take us closer to the end goal of an electronic and value-driven health care system because it is entirely likely that the system will continue to evolve beyond the conclusion of Stage 3 and the final stimulus payments. The goal is to put the full measure of health information technology to good use in making health care everything it can be. We will see registries and evidence-based care normalized. The Clinical Decision Support technologies within EHRs will continue to expand, and care will become all about patient outcomes. Patient care will be less about what the doctor did and more about what the patient experienced.

The Hidden Technologies
What sets vendors apart are the hidden technologies that vendors must cover in their certification but end users are not necessarily aware of. Are they ahead of the curve or behind it, leading or following?

Two technologies in particular are Direct Transport and Provider Notification. Direct Transport is a secure messaging technology required for Stage 2. Vendors should have this in place now. Provider Notification is the subject of two new CPT codes designed to reduce hospital re-admissions. The codes apply directly to primary care physicians but indirectly to specialists, including ECPs, who are involved in the patient’s care team. Direct enables the use of Provider Notification.

EHRs and steps to compliance can only take us so far. Enjoyment and fulfillment lie beyond in reflection on new concepts, principles and the opportunities in health care reform. They’re there, they’re exciting and will be motivating for the years ahead. ■

—Alistair Jackson, M.Ed.

Alistair Jackson, co-author of “The Value-Driven Eye Care Game, A Player’s Survival Guide,” served for 12 years in sales, marketing and business development for an eyecare software company. His new consultancy, Eye Care Advice, informs ECPs about the impact of health care reform on eyecare. Read more at