Article Date: 1/1/2012

The State of EHR in Optometry

The State of EHR in Optometry

Optometrists are steadily adopting electronic health records. Is it time to pick up the pace?

Lee Ann Murphy
Contributing Editor

The electronic health records (EHR) train continues to pick up speed, and optometrists are starting to jump on board in greater numbers. But if the goal is to get the majority of doctors to buy a ticket and take a seat by October 2012 — the last chance for healthcare providers to begin reporting on Meaningful Use (MU) if they want to see all the incentive money they are eligible for — then the industry might just need a louder conductor yelling “all aboard.”

“Optometrists are slowly adopting electronic health records,” says Anthony Diecidue, O.D., president of Mountain Computer Systems, a Stroudsburg, Pa.-based EHR company. “We're probably ahead of some of the specialties, but in general the adoption process is still slow.”

“Generally, the adoption rate of O.D.s is behind that of PCPs, who passed the 50% mark in mid-2011,” says Ian Lane, O.D., vice president, technology, Kowa Optimed, Torrence, Calif., which offers activEHR software.

Slow is not an option for those who want to take full advantage of the government incentive payments, say vendors.

Fortunately, there is evidence that optometrists are beginning to heed the EHR call.

“If our client base is any indication, many doctors implemented [EHR] in 2011, and those who didn't are planning to do so in 2012,” says Mary Ann Fitzhugh, vice president, marketing, Compulink Business Systems, Inc., a West Lake Village, Calif.-based practice management software company. “The incentive payments are driving this behavior.”

Jim Kirchner, O.D., chief professional strategies officer of Eye-Finity, a Rancho Cordova, Calif.-based practice management software company, agrees that the momentum is building. “I see great progress,” he says. “If you look at where we are today versus where we were a year ago, it's been a big surge …,” he says.

Yet despite this “surge,” many doctors remain skeptical about adopting EHR. To sort it out, we asked those who have the most experience with EHR systems, the vendors.

Hurdles in adoption

Why have some doctors have avoided transitioning to EHR? Those interviewed offer several reasons.

“There appears to be a fair amount of misconception among the O.D. community regarding the necessity to adopt certified EHR and the uncertainty around ‘Obama Care,’” answers Dr. Lane. “They are not the same.”

Specifically, the American Recovery and Reinvestment Act of 2009, not healthcare reform legislation, specifies the main components of EHR MU.

But perhaps the tallest hurdle to overcome in adopting EHR — even more so than the cost — is simply the fear of changing the way a practice has always examined patients and recorded data.

“Doctors have been afraid to move away from their paper files because they have to change everything they do in the exam room to a computer system …” says Scott Jens, O.D., F.A.A.O., CEO of RevolutionEHR, a Madison, Wisc.-based EHR software company.

Jorge Torres, sales manager, at Insight Software, a Weston, Fla.-based EHR software company, adds, “The main resistance we see is that it's going to slow them down in the exam room,” he says. “Paper and pen can be very efficient, and the computer is hard pressed to replace that efficiency, at least initially. But once practices get the system in place and get familiar with it, they can be very efficient.”

In addition to the efficiency of EHR, Dr. Lane cites a number of benefits to the practice: greater organization, maximized insurance reimbursement, enhanced patient care, greater in-office access to patient information, remote access for after-hours patient care and error reduction.

“For example, sometimes just the reduction in optical prescription redo's will more than offset the cost of the e-prescribing,” says Dr. Lane.

“EHR is good for patient care, says Dr. Jens. “There are fewer errors, and eventually, once data sharing and interoperability come into the mix, we'll know exactly what medications our patients are on without having to ask them.”

Practices should also look ahead, says Dr. Diecidue. “The future is EHR. The government has invested billions of dollars into this. Data will be transmitted electronically whether it's to pharmacies, hospitals, doctors, and if you can't do that, you'll be left out.”

Providing education

“Many optometrists are hesitant to buy an EHR due their misunderstanding of what an EHR really is,” says Michelle Rovner, advertising and media relations associate at NEXTGEN Healthcare, a U.S. company which provides EHR, financial, and HIE solutions. “Providing hands-on education about EHRs is essential in getting doctors to take that step toward adoption. They need to be aware that EHRs are an essential tool and serve as a clinical assistant capable of helping them in many valuable ways.”

EHR shouldn't be an impediment, but that's how many doctors see it, says Ms. Rovner. Doctors who have been working the same way for decades aren't used to stumbling through a transitional period, she explains. So, as the first step toward acceptance among optometrists, vendors must make the case that EHR is more than a paper-chart-turned-electronic — it is a paradigm shift, but one which practices can adjust to, Ms. Rovner explains.

Korry Petterson, president of FoxFire Systems Group, a Sioux Falls, S.D.-based company that provides practice management and EHR software, among other products and services, agrees that vendors need to step up the education on the benefits of EHR. “It's on us as vendors to show doctors how, given time with the system, we can make them much faster and more accurate than hand-written records.”

The training dilemma

Another challenge that practices face is that once doctors say “yes” to EHR, they have the daunting task of training and implementation.

“One of the greatest obstacles practices face in implementation is that doctors and staff are not prioritizing training sessions until just before the office goes live with the EHR,” says Dr. Lane.

Practices often delay training as much as possible because they equate training and implementation with downtime, he says.

“Doctors are really concerned about the disruption to their workflow and business and how they and their staffs will get trained,” adds Ms. Fitzhugh.

Support from the vendor is essential, and every doctor needs to know how the vendor will bring them through the transition up front, say those interviewed. However, accepting that downtime is inevitable in the short-term and doing the proper training during implementation will save additional time and money in the long run, says Dr. Kirchner.

IT upgrades

Another hurdle for doctors can be the issue of hardware investment. Even for current EHR users, there is anxiety about upgrading to a system that requires significant new investment in equipment. And for those who are starting at square one, the prospect of making large investments in hardware can be another reason to avoid an investment in EHR.

Unfortunately, hardware upgrades are almost always inevitable, say those interviewed.

“From what we've seen, most don't have the IT infrastructure to support EHR, whether it's desktops, tablets, servers or even the bandwidth needed,” says Ms. Fitzhugh. “That's why most O.D.'s are really concerned about the cost of going to EHR.”

Says Dr. Jens: “The computers that run EHR can be simple workstations, but they must have the ability to handle a lot of information processing,” he says. “Internet speed is an important consideration of web-based systems. Server set-up, maintenance and replacement costs are important considerations for server-based systems.”

Many vendors now offer systems that operate over the Internet. While these “Cloud-based” systems don't require servers, they do need computers with good processor speed and RAM, decent-sized monitors (17-inch or better) and a high-speed Internet connection.

Donna Lehman director of marketing communications at First Insight Corporation, a Hillsborough, Ore.-based eyecare software manufacturer, suggests that those who find themselves updating workstations and other hardware should lessen the long-term sting by going beyond what is needed right now.

“We highly recommend that practices exceed hardware minimum requirements for processor speed and RAM to stay ahead of advancing technology,” she says. “There are more changes coming down the road, and having to upgrade yet again in a year or two is more frustrating than doing it all now.”

Integrating EHR with diagnostic equipment

Integration with existing equipment is another challenge practices face with EHR implementation.

“Some doctors realize after the fact that they're going to need a new auto refractor because the old one doesn't have a digital interface,” says Mr. Torres. “If you have an old auto refractor, that data has to be coded into the EHR manually, whereas if you have modern equipment we can interface that directly with the EHR to capture that data right in. That's a huge time saver. It's probably one of the main installation issues — how to handle the existing diagnostic equipment in the exam room.”

“We recommend that practices discuss ancillary equipment requirements with their EHR vendor before they purchase anything,” says Ms. Lehman. “Ask your EHR vendor if your diagnostic equipment is compatible with your EHR system and can easily transfer readings to a patient record.”

“It's important that physicians look at the software designed to accommodate the unique needs of ophthalmic subspecialties and ensure scanning software ophthalmic inventory management, and device interfaces are options offered before selecting a vendor,” adds Ms. Rovner.

Doctors who already use practice management systems must also make decisions about whether to keep their old system or migrate to a new one, say those interviewed.

Unraveling MU

One of the looming short-term issues in implementing an EHR system involves understanding MU.

“There are criteria that go into meaningful use that doctors have not taken time to understand,” Dr. Kirchner says. “Some mistakenly think they will just wait and get a certified system, put it in the office and get meaningful use done because the system will do it automatically.”

Achieving MU is a two-way street, according to Dr. Lane.

“Vendors supply, implement and train on the use of the EHR, assist with workflow optimization and provide compliance protocols and how to generate reports to support MU if the doctor is registered for reimbursement,” he says. “Doctors' offices are responsible for using the EHR in a meaningful way in order for the system to provide the ability to enhance patient care, compliance, security and improved business performance. No system can optimize data or information if the office chooses not to follow the recommended workflows.”

The bottom line: Software that is certified for meaningful use gives eligible providers (EP) the ability to perform a meaningful use examination — “it doesn't do it for you,” says Dr. Diecidue.

EPs also need to be aware of other details, such as exclusions to MU criteria that may be available to the practice, notes Mr. Torres. For example, many optometrists believe that to achieve MU, they will have to begin taking height, weight and blood pressure measurements for all patients. But if it's not relevant to the scope of their practices, doctors have the option to opt out, he says.

To plan for MU, doctors must be proactive and understand all the rules and core and menu set objectives. For those unfamiliar with MU, the rules may appear complicated.

“Eligible providers must use a certified EHR for 90 consecutive days [in order to receive the incentive payments],” says Ms. Lehman. “Eligible providers must also send compliant electronic prescriptions to pharmacies, electronically exchange patient health information with labs, hospitals, providers, payers and other EHR and submit compliant clinical quality measures.”

Looking for a help desk

When the MU attestation process becomes too complicated, vendors can't do the work for the EP, but they can offer assistance.

“In principal, the certified EHR system should give doctors the reports they need to attest,” says Ms. Fitzhugh. “However, we've found, in practice, that our clients have needed a lot of handholding in understanding meaningful use — both the process and what they were reporting on. We've had to support them every step of the way. You need to make sure the vendor you select will be there to support you with MU consulting and advice and not just toss software over the wall at you.”

The partnership between a doctor and the EHR vendor “is essential,” says Dr. Lane.

“The software is in a continual state of enhancement both from a regulatory as well as additional functionality and usability,” he says. “Sharing information on how to improve usability is a key.”

The steps ahead

Regardless of how well EPs begin their journey toward MU, this is only the beginning.

“A lot of doctors don't realize this is just stage one, and (the MU process) is going to increase in complexity with stages two and three,” says Mr. Torres.

For example, in the future, your EHR will need to be connected to the Centers for Medicare and Medicaid Services (CMS).

“It's on the doctors to continue their education and stay on top of things,” says Mr. Torres.

Says Ms. Fitzhugh: “This changing regulatory landscape is going to be challenging for providers who before this time had little information beyond what was needed to process a claim. This will be a new environment that providers absolutely need to participate in.”

For those who have already implemented EHR systems, Dr. Lane sees several challenges on the horizon. For EPs, the challenges include complying with the next stages in MU and deciding how to move forward efficiently in those cases in which installed EHR systems have poor usability.

“Certification does not test ease of use,” notes Dr. Lane.

Despite the confusion and daunting challenges, it's important for doctors to see through the fog to the fact that this is all meant to improve outcomes for patients.

“The government is driving us through these changes in the effort to get doctors meaningfully using electronic health records,” says Dr. Kirchner.

But using the software in a single practice is not the end goal, he says. The future will include the ability to share data across specialties so doctors can increase the quality of care and improve outcomes.

“America is not healthy, and this whole process is the foundation to give us the tools we need to improve the health of America …,” Dr. Kirchner says. That's why it's so important that doctors get involved now.” OM

Ms. Murphy s a freelance writer and editor based in Fairfield County, Conn. For comments, e-mail

Optometric Management, Volume: 47 , Issue: January 2012, page(s): 30 - 34