Advocates hope that electronic medical records become synonymous with health care efficiency, safety, improved patient care and reduced costs. However, questions remain regarding issues such as universal standards, security and systems that are specifically geared toward ophthalmology practices.
In 2004, President George W. Bush called for all Americans to have electronic medical records (EMRs) by 2014, and EMRs are a key component of President Barack Obama’s health care reform strategy. Incentives for EMR adoption are also a key feature of the economic stimulus bill President Obama signed soon after taking office.
Electronic medical records, also known as electronic health records (EHRs), are dedicated or Web-based computer platforms or software packages designed to partially or completely eliminate paper records. EMRs perform practice management functions, such as billing and scheduling, and clinical functions, such as storage and retrieval of patient charts and images. Some systems perform both functions.
Some EMRs also handle electronic prescribing, in which patient and prescription information is transmitted from the physician’s office to the pharmacy.
The Certification Commission for Healthcare Information Technology (CCHIT), a nonprofit federal government contractor, certifies EMR systems. The CCHIT certifies ambulatory, or office-based, EMRs and hospital-based EMRs; certification is based on functionality, security and interoperability, or the capacity for systems to communicate with one another and integrate clinical images with patient data.
Interoperability is particularly critical to the efficacy of eye care EMRs, experts say.
Currently, there are no EMRs certified specifically for eye care, but there are systems certified for ambulatory care being used in eye care practices. In ophthalmology, committees comprising clinicians, researchers and manufacturers are devising interoperability standards, and CCHIT certification criteria for eye care EMRs are expected to be completed in 2011.
“We are trying to work toward [certification.] We want to get it,” Flora Lum, MD, American Academy of Ophthalmology policy director of quality of care and knowledge base development, said. “We applied 2 years ago, and we applied last year. We did get accepted, but we’re not starting until 2010. We anticipate having criteria in place around mid-2011.”
Ophthalmology and other specialties face a serious dilemma with EMRs. The American Recovery and Reinvestment Act of 2009, the federal economic stimulus bill, called for substantial financial incentives for physicians who adopt EMRs starting in 2011, before CCHIT-certified eye care EMRs enter the market, William L. Rich III, MD, FACS, the American Academy of Ophthalmology’s Medical Director for Health Policy, said.
The AAO is urging the Senate Finance Committee to delay the incentives until CCHIT-certified eye care EMRs become available, Dr. Rich said.
“The Academy feels that the timeline for the bonuses and penalties has to be pushed back,” he said. “We’re not going to be up and running with CCHIT-certified EMRs by 2012. It’s just not going to happen. They’re talking about developing the criteria in 2011. We feel very strongly that as it’s structured now, ophthalmologists are not going to be able to participate.”
Dr. Rich strongly advises ophthalmologists to delay EMR purchases until eye care systems are certified. Those who choose to adopt EMRs sooner should do so to improve efficiencies but disregard the incentives, he said.
“My strong message to practicing ophthalmologists is that unless you’re in an integrated system like a university, do not buy an EMR because you don’t know what you’re getting,” Dr. Rich said. “If you can buy an EMR or some sort of document management system, you should base that decision on what it can do to change your efficiency at this point and totally disregard the whole issue of the bonus because I just don’t think it’s feasible.”
Incentives are up to $44,000 over 5 years for physicians who adopt EMRs in 2011 or 2012, up to $39,000 over 5 years for those who adopt in 2013 and up to $35,000 over 5 years for those who adopt in 2014. Physicians who adopt EMRs in 2015 or later face a 1% to 5% decrease in Medicare reimbursement.
Source: DSN Supersite