PRACTICE STRATEGIES PRACTICE STRATEGIES

Electronic health records objectivesPhilip J. Gross, O.D.

he 2009 American Optometric Association (AOA)

TNew Technology survey confirms that optometristsare becoming increasingly sophisticated in their use

of technology (AOA: 2009 AOA New Technology SurveyHighlights available at www.aoa.org/x13329.xml). The sur-vey finds that three quarters of responding AOA memberpractitioners now issue patient appointment reminders elec-

The U.S. Department of Health & HumanServices (HHS) has established objec-tives for the utilization of electronichealth records (EHRs) in health carepractices. The American OptometricAssociation Health Information Tech-nology and Telemedicine Committeeurges optometrists to become familiarwith them now.

tronically. More than two thirds of respondents order lensesonline from ophthalmic labs. More than a third interface prac-tice management software technologies with electronic healthrecord (EHR) systems.

However, the survey also suggests that many optometristsare still not making use of all the features and functionstoday’s health information technology (HIT) offers. Forexample, only about 1 in 5 optometrists use EHR systemsto maintain complete patient health records. (In manycases, practitioners appear to be using the systems primar-ily to record basic patient name and address information foruse in claim filing and recall notices.) Only about 10%prescribe pharmaceuticals electronically (e-prescribing).

However, with the government ready to begin providingsubstantial EHR incentives in 2011, new Medicare payment

The is the second in a series of articles prepared by the AOA Health Infor-

mation Technology and Telemedicine Committee to help optometrists im-

plement EHRs in their practices before the start of the American Recovery

and Reinvestment Act EHR incentive program. Philip J. Gross, O.D., is the

committee chair. AOA members with questions on electronic health rec-

ords can contact committee staff person Mary Beth Rhomberg, O.D., at

MBRhomberg@aoa.org. Opinions expressed are those of the author and

not necessarily those of the American Optometric Association.

1529-1839/10/$ -see front matter � 2010 American Optometric Association. Al

doi:10.1016/j.optm.2010.01.007

penalties to be imposed in 2015, and the Nationwide HealthInformation Network (NHIN) set for launch in 2014,optometrists and other health care practitioners will soonhave good reason to make more extensive use of HIT (seeWhy optometrists should act on EHRs now. Optometry2010;81:162-4).

As part of an overall program to improve the quality,safety, and efficiency of American health care whilereducing health disparities among various segments of thepopulation, the U.S. Department of Health & HumanServices (HHS) is taking steps to encourage the ‘‘mean-ingful use’’ of EHR technology. To that end, in December2009, the department proposed objectives for the utilizationof EHRs in health care practices, listing ways practitionerscould use EHR systems to enhance the quality and efficacyof care. Based on recommendations from the department’sHIT Policy Committee, the objectives call for practitionersto utilize EHR technology for a range of functions, fromthe ordering and prescribing of health care products, to theelectronic reporting of potential public health threats.Practitioners will have to achieve those objectives toqualify for EHR incentive payments, escape Medicarepayment penalties for nonuse of EHRs, and, ultimately,participate in the NHIN (which could soon become neces-sary for any practitioner who wants to be a part of theAmerican health care system). To be certified for use in theNHIN, or the government incentive programs, EHR soft-ware will have to provide practitioners the functionsnecessary to achieve those objectives.

The HHS’s HIT Policy Committee has recommended atotal of almost 60 EHR objectives. While EHR programsmust immediately provide all of those functions to wincertification, health care practitioners will, at least initially,have to achieve only certain specified objectives to dem-onstrate meaningful use. During 2011, the first year of thefederal HITECH incentive program, health care practi-tioners will probably have to demonstrate they haveachieved about 20 objectives, which will constitute ‘‘Stage1’’ meaningful use of electronic health records. The HHSplans to define 3 advanced stages of EHR use in thecoming months. Health care practitioners who achieveStage 1 meaningful use will eventually be expected tograduate to higher stages of EHR use. (The HHS has alsoannounced that it will periodically redefine the criteria forStage 1, Stage 2, Stage 3, and Stage 4 EHR use,presumably increasing requirements for each stage. For

l rights reserved.

Box 1

HHS electronic health records ‘‘meaningful use’’ objectives for2011Improving quality, safety, and efficiency and reducing health disparities� Utilize Computerized Physician Order Entry (CPOE)� Do drug–drug, drug–allergy, drug formulary check� Maintain up-to-date patient primary problem and active diagnoses list (using ICD-9-CM or SNOMED CT�) (at least

1 entry or indication of no active problem)� Use e-prescribingdPermissible pharmaceutical prescriptions (those not prohibited under U.S. Food and Drug

Administration regulations on controlled substances) generated and transmitted electronically with certified EHRtechnology

� Maintain active medication list� Maintain active medication allergy list (at least one entry or ‘‘none’’)� Record demographics (preferred language, insurance type, gender, race, ethnicity, date of birth)� Record and chart changes in vital signs (height/weight, blood pressure, body mass index, growth chart [children

2 to 20])� Record smoking status (patients over age 13)� Incorporate clinical lab test results into EHR� Generate at least 1 list of patients with a specific condition (for use in quality improvement, reduction of disparities,

and outreach)� Report ambulatory quality measures to the U.S. Centers for Medicare & Medical Services (or state Medicaid agency)� Send reminders of preventive or follow-up care (patients age 50 or older).� Maintain clinical decision support rules relevant to practice� Check insurance (public and private) eligibility electronically� Submit claims to public and private insurance plans electronically

Engaging patients and families in their health care� Offer patients electronic copies of their health information (within 48 hours).� Provide patients timely (within 96 hours) access to their health information (lab results, problem list, medication list,

allergies)

Improving care coordination� Maintain capability to exchange key clinical information (e.g., problem list, medication list, allergies, diagnostic test

results)� Perform medication reconciliation at relevant encounters and at each transition of care and referral� Provide summary care record of each transition of care and referral

Improving population and public health� Submit electronic data to an immunization registry� Provide electronic syndromic surveillance data to public health agencies.� Conduct a Health Insurance Portability and Accountability Act (HIPAA) security risk analysis (or review past

analysis)

206 Practice Strategies

that reason, the sooner practitioners demonstrate meaning-ful EHR use, the easier it will be.)

The HHS’s 20 proposed Stage 1 EHR implementationobjectives applicable in 2011 are listed in Box 1. The AOAHealth Information Technology and Telemedicine Commit-tee has categorized the objectives in line with the HHS’soverall health enhancement goals (‘‘Engaging patients andfamilies in their health care,’’ ‘‘Improving care coordina-tion,’’ etc.). The HHS has indicated that Medicare Physician

Quality Reporting Initiative (PQRI) participation will even-tually be considered an EHR meaningful use objectivedalthough, initially, in only a very limited fashion. Even-tually, however, greater reporting of health care qualitymeasures will be required for the meaningful use of EHRs.

For each objective, the HHS is developing specific EHRimplementation ‘‘measures,’’ not unlike the quality of caremeasures used under the Medicare PQRI. By reporting thatthose measures have been taken, a practitioner will be able

Practice Strategies 207

to document that an EHR utilization objective has beenmet. Health care practitioners will have to take those spe-cific measures for specified numbers or percentages of pa-tients. In a few cases, at least during 2011, simply havingthe EHR capability to achieve the objective or providingan EHR function for a limited number of patients will besufficient to demonstrate meaningful use. In most cases,however, practitioners will have to provide the EHR func-tion for a substantial number of patients.

Specific measures and patient percentages (still beingfinalized as this article was prepared for press) will bereported in future Optometry articles as well as in AOA News

on the AOA Web site Electronic Health Records page(www.aoa.org/EHR.xml). It should be emphasized that theHHS had not finished the objectives listed here as this articlewent to press. Some changes could be forthcoming. How-ever, optometrists should start to be become familiar withthe HHS’s EHR meaningful use objectives now. Moreover,they should begin to consider how each function will be in-corporated into their practices and used to enhance patientcare. Taken together, the objectives provide an indicationof the way HHS officials hope to see EHRs used to benefitindividual patients and improve the health of the nationoverall.