Exam Lane: EHR EHR: ‘Everywhere’ Health Records By John Sailer Friday, September 6, 2013 3:30 AM RELATED CONTENT The Intelligent Office How to Make Sure Your EHR ‘Use’ Is ‘Meaningful’ Automating the Exam Lane With Software Integration Late to EHR? Financial Incentives Are Still Available The Result: Care Coordination and Improved Outcomes By John Sailer: Senior Editor Electronic health records are no longer “theoretical.” Here, there and everywhere, they are a “reality,” quickly on their way to becoming ubiquitous, following the patient every step of the way through their health care experience. Involvement in EHR is also now being described as a “necessity” for eyecare practices and optometric offices, VM has confirmed, via conversations on the topic with market leaders, practitioners and EHR executives. Since their initial implementation about two decades ago, EHR systems have evolved from glorified charts to sophisticated and integrated software systems that are poised to provide the foundation on which a major transition in health care will be built. EHR will provide not only the hub that stores the patients’ health information but will also become the spokes through which that information is shared via handheld devices and desktop computers, both with the patients themselves as well as with other practitioners on the health care team. For optometrists, this will mean that their time is freed up from the mundane chore of creating and managing a patient’s health records through older techniques and manually managed files, so they can focus more on the patient’s health itself. The driving force behind these changes is a new generation of cloud-based EHR systems which are being introduced with intuitive, adaptive learning interfaces. Patients are already beginning to populate patient health record databases with their own medical histories. Health information exchanges are being built and deployed to enable doctors to interact among themselves and with their patients. Instigating the implementation of all of these, incentive payments for achieving Meaningful Use Stages 1 and 2 are encouraging doctors to install electronic health records systems in their offices. Of course, as with any dramatic overhaul of existing systems, converting to electronic health records is not without its challenges. These can include a steep learning curve, electronic communication difficulties, and image management issues, among other roadblocks and detours. Still, as deadlines approach and pass, experts observe that EHR is here and here to stay as an integral part of health care reform. It’s time for eyecare professionals to join in or be left out of the new health care landscape. It’s time for ECPs to step up their EHR game to be ready for what’s coming next—interoperability and instant access. It’s no longer safe to stay on “vision island,” as EHR consultant Alistair Jackson, a former executive of EMRlogic and now with his own consultancy firm, Eye Care Advice, explains in his book, The Value-Driven Eye Care Game, A Player’s Survival Guide. “The number of ODs embracing EHR is on a significant rise,” he said. ECPs Embrace EHR Patient engagement systems, such as 4PatientCare, can integrate with EHR software, such as My Vision Express, to streamline scheduling and many other processes. While EHR systems were gradually establishing a foothold in ECPs’ offices prior to the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, since then the financial incentives provided by that legislation have encouraged the implementation of EHR to grow by leaps and bounds. As of June 2013, 12,371 optometrists have registered their certified EHR programs for incentive reimbursements under the HITECH Act and have received payments of $151 million over the course of the program. Beyond the optical field, among all eligible professionals, the Department of Health and Human Services has surpassed its goal of having 50 percent of doctors and 80 percent of hospitals using EHR. “We have reached a tipping point in adoption of electronic health records,” HHS Secretary Kathleen Sebelius announced in a press release in May 2013. EHR use among physicians has increased from 50,000 in January 2012 to nearly 300,000 in April 2013, according to HHS data. From scheduling their appointment, to their examination, and all the way through their follow-up care, patients can have immediate and constant connectivity to their electronic health records, streamlining the process for themselves and vastly improving the overall efficiency of health care. Digital Health Care Goes to the Cloud (L to R) Tommy Crooks, OD, Lorie Lippiatt, OD, and Kim Castleberry, OD, were instrumental in the creation of VisionWeb’s Uprise EHR software. Constant connectivity, continuation of care, provider notification, patient portals, health information exchanges and interoperability are just some of the buzzwords that will inhabit the new health care landscape. As patients continue embracing the digital world that already inundates most aspects of our lives through smartphones, tablets, laptops, desktops and other electronic devices, they will soon expect the same instant access to information related to their health care. While early adopters of EHR may have been required to take on more of the information technology (IT) tasks than they might have liked while using legacy server-based programs, most of the current programs are going to or have already gone to “the cloud.” Rather than storing data onsite in the doctor’s office on computers that require regular maintenance and continuous upgrading, it is sent to a remote server farm where all updates are automatically performed. Any internet connection will suffice to enable the ECP to access that data, and practitioners have established redundancies so that if one conduit to the web is down another is readily available. Anywhere and at any time, a patient’s records can be accessed immediately. “I can go home, log into my home computer, do my charts, finish up my day and check my schedule for the next day,” said James E. Harris, OD, FAAO, of Modern Eye Care in Concord, N.C., about the RevolutionEHR cloud-based system his practice has been using since 2009. Also, while the EHR programs themselves eliminate the need for the extra square footage it takes to store cabinets full of paper files, going to the cloud further frees up space by limiting the amount of hardware necessary onsite as well. The digital world of health care is close, and electronic health records are the vehicles that will drive both patients and doctors to that destination. The following breakdown details how EHR systems and the information they store and share permeates the patient experience within and beyond the ECP’s office. ■ ■ Portal Power: Connecting Patients With Practitioners Everyone’s familiar with the experience of visiting a practitioner’s office for the first time and being asked to arrive at least 15 minutes early in order to fill out paperwork and the inevitable clipboard of forms that comes along with that request. Portals that allow new patients to electronically complete all of those intake forms online, on their own time and in the comfort of their own home, can completely eliminate this step and enable the patient to accomplish this task at a time of their own choosing before setting foot in the doctor’s office. When the patient arrives at the ECP’s office for the first visit, all of their contact information, health history, insurance details and any other pertinent data will have already populated the office’s practice management and electronic health record systems. For those patients who choose not to complete their forms prior to their first office visit, they might be handed an iPad or other tablet device to electronically enter their information once they arrive. Either way, the data can be automatically transferred to the doctor’s electronic records; no more keying in the information and no more errors that might accompany that extra step. Other benefits include the opportunity to complete basic tasks such as paying bills and scheduling appointments online as well as the ability to communicate directly with the ECP and electronically manage personal health records. “Having a patient portal is a hot topic for EHR,” said Mathew Petersen of My Vision Express, which offers one free with its web-hosted software solution. And once Meaningful Use Stage 2 goes into effect, patient portals will not only be hot…they’ll be mandatory. “Using a portal, patients can communicate with the doctor, pay their bill online, reorder contacts, manage their appointments, monitor the care they’re receiving and be proactive,” he said. “Using the portal gives patients access to look at their accounts, see their medical records, find out if their glasses or contact lenses are ready, and if not, what’s their status,” added James E. Harris, OD, FAAO, of Modern Eye Care in Concord, N.C., who has been using RevolutionEHR’s cloud-based system in his practice since 2009. Engaging the Patient Jeffrey J. Guterman, MD, MS, chief medical officer, 4PatientCareCommunication goes both ways, and there are a number of systems that also enable ECPs to stay in touch with their patients when they are not in the office. These include Demandforce, Solutionreach, Websystem 3 and 4PatientCare, all of which can integrate with certain EHR systems. In other cases, these patient communication systems can also be embedded into the EHR software. For example, 4PatientCare comes “baked into” Uprise, Jeffrey J. Guterman, MD, MS, chief medical officer of 4PatientCare told Vision Monday. It’s ready to run as soon as the office installs the software. Harris uses Solutionreach with the RevolutionEHR system he’s installed. “For recalls, patients can choose whichever they prefer, text, e-mail or phone call,” said Harris. “When the patient responds, it goes directly into our system.” Solutionreach also recently streamlined its integration with MaximEyes, giving users of the First Insight software program instant access to these patient engagement tools. Many more examples illustrate this type of integration for improved interaction between the patient and the practitioner’s office.