Originally published in AOA News, Volume 49, December 2010
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New Web-based Optometric EHR Product Certified before Incentive Program Begins January 1, 2011

Last month’s certification of the first Web-based optometric electronic health record (EHR) product provides evidence that optometry may be as well prepared as any segment of American health care for the start of the Health Information Technology for Economic and Clinical Health (HITECH) incentive program, said Philip Gross, O.D., chair of the AOA Health Information Technology (HIT) Subcommittee. The products are certified to meet U.S. Department of Health & Human Services (HHS) standards.

Madison,Wis.-based Health Innovation Technologies, Inc., announced Nov. 23 its RevolutionEHR version 5.1.0 had been certified by the Certification Commission for Health Information Technology (CCHIT®), a federally authorized testing and certification body (ATCB), as an EHR module, providing functionality necessary to support participation in the incentive program. The firm becomes the fourth provider of optometric EHR products to achieve certification for the federal incentive program that begins Jan. 1, 2011.

“It appears that many optometrists around the nation could be in a position to take part in the HITECH incentive program during 2011,” Dr. Gross said. “Certainly EHR implementation will pose challenges for optometric practices. Many optometrists continue to have questions about EHRs and the federal incentives. Most ODs probably will not have certified EHR systems fully integrated into their practices for the start of the program on Jan. 1. However, many optometric practices should be able to very quickly upgrade their practice software systems to meet incentive program requirements. Those implementing EHRs for the first time will clearly have a range of certified systems from which to choose. Attendance at our AOA Electronic Health Records Preparedness courses, as well as traffic at our AOA Web site EHR page, has been substantial, suggesting many optometrists are staying abreast of EHR developments and could be ready to implement EHRs during the first year of the incentive program. This could help to ensure they receive maximum total payments under the incentive program. Ultimately, it could also help to establish optometry as a leader in EHR utilization and thereby help to reinforce optometry’s position as an important part of American primary health care.”

With last month’s announcement, at least 4,700 optometric practices now have patient record systems that can be upgraded to meet incentive program standards, according industry representatives.

Close to 4,000 optometrists have attended the AOA EHR Preparedness Course since it was introduced early last year, according to the AOA HIT Subcommittee.

Under the five-year federal incentive program, eligible health care practitioners will be able to quality for up to a total of $44,000 in incentive payments through Medicare ($48,400 in federally designated health profession shortage areas), or up to $63,750 through Medicaid, by implementing EHR systems that have been certified for use in the program and meeting designated EHR utilization criteria, known as the “meaningful use” standards.

The Medicare incentive program is mandated under federal law to begin on Jan. 1.

Medicaid EHR incentive programs could begin as early as that date.

Optometrists are specifically included in the Medicare incentive program nationwide; however, they can qualify for EHR incentives through Medicaid only in those states that recognize optometrists as providers of physician services under Medicaid.

During 2011 and 2012, health care practitioners will be able to qualify for Medicare incentives by achieving HHS-designated Stage 1 meaningful use, a process that involves achieving 20 utilization objectives.

The Stage 1 objectives consist of a group of 15 “core” objectives required for all practitioners and a list of “menu” elements from which practitioners may select five and defer five.

To earn incentives for Stage 1 meaningful use, health care practitioners must attest compliance with the specified objectives for 90 days.

That means health care practitioners who promptly implement certified EHR systems and begin achieving meaningful use objectives by the start of the year could attest compliance as early as April and receive incentive payments as soon as May, according to the HHS.

However, most practitioners who enter the program during 2011 probably will attest compliance over the course of a 90-day reporting period sometime later in the year, the AOA HIT Subcommittee notes.

HHS officials plan to issue instructions for Medicare incentive program registration and attestation over the coming weeks. Both registration and attestation will be accomplished through specially designated Web sites, the agency says.

Web-based EHR

Testing and certification agencies, designated by the HHS’s Office of the National Coordinator of Health Information Technology (ONC), offer certification for both complete EHR systems that provide all of the functions necessary to achieve meaningful use and EHR modules providing some, but not all, of the functions necessary to provide a complete EHR system.

The certification of RevolutionEHR’s Web based EHR last month follows the certification of three soft-ware-based optometric EHR products.

Westlake Village, Calif. -based Compulink Business Systems, Inc., became the first to be certified when its Advantage EHR Version 10 package was certified on Oct. 14 as a complete EHR by the CCHIT.

Irvine, Calif.-based Eyefinity/OfficeMate announced that its OfficeMate/ExamWriter Version 10 was certified Oct. 29 as a complete EHR.

Hillsboro, Ore.-based First Insight Corporation announced that its MaximEyes SQL Electronic Health Records, Version 1.1.0.0, was certified Nov. 2 by the CCHIT as an EHR module.

“Web-based systems, such as RevolutionEHR, are designed to ease the process of EHR implementation in a health care practice,” according to Health Innovation Technologies CEO Scott Jens, O.D. “Using any commonly available personal computer with Internet access, practitioners or authorized staff can log onto a Web site where EHR functions are already installed and ready for use. No software needs to be installed on the office computer. The system operator provides secure connections for transfer of records to other health care providers, data reporting, and other required functions,” Dr. Jens said. “Secure storage of records is also provided. As EHR systems evolve, software updates are handled entirely by the Web host,” he added. Practitioners do not need to purchase, install or test software updates.

The RevolutionEHR system was certified last month as a module providing functionality that will allow practitioners to maintain up-to-date health care problem, active medication, and active medication allergy lists; record patient demographics and smoking status; record and chart patient vital signs; and perform medication reconciliation.

However, “RevolutionEHR will seek certification for the additional functionalities required in a complete EHR by the end of the year,” Dr. Jens said. E-prescribing will be accomplished through Annapolis, Md.-based Networking Technology’s already CCHIT-certified RxNT system, according to Dr. Jens. Secure record storage will be provided by Wayne, Pa.-based SunGuard. The RevolutionEHR system has already been certified to provide the security features (access control, emergency access, automatic log-off, audit log, integrity, authentication, general encryption, and encryption when exchanging electronic health information) required of EHRs under the incentive program.

“The phased rollout, facilitated by the RevolutionEHR system’s Web based architecture, will allow subscriber optometrists to begin incorporating some of the meaningful use components in their patient care as soon as possible, before they register with the CMS for the incentive program,” said Dr. Jens.

At least one additional Web-based optometric EHR is under development. Overland Park, Kans.-based QuikEyes Software, Inc., expects its optometric EHR software package to be certified for use under the HITECH program during first quarter of 2011, according to company founder and president Matt Lowenstein, O.D.

In addition, Lincoln Neb.-based Practice Director Software, a division of the Williams Consulting Group, plans to have its EHR program tested for certification during the first quarter of 2011, according to Brad Rourke, the company’s vice president.

Achieving Meaningful Use

Most optometric practices should be able to accomplish the objectives necessary for meaningful use, Dr. Gross believes (see “Achieving EHR meaningful use objectives in an optometric practice” in the Practice Strategies section of the December issue of Optometry: Journal of the American Optometric Association). About half of the objectives will involve implementing technological functions (clinical decision support, computerized physician order entry [CPOE], e-prescribing) that may be new to an optometric practice, he acknowledges. However, half or more of the core objectives involve routine functions (recording patient demographics, compiling patient medication lists) that are commonly performed as a part of normal patient recordkeeping in virtually any practice, he adds.

Certified EHR products must have readouts that will allow practitioners to check on their performance in meeting meaningful use objectives, Dr. Gross notes. Many practitioners will probably use that feature to ensure they have met the necessary criteria over the course of a 90-day reporting period, before formally applying for incentives, he said.

During a recent series of presentations before health care practitioner organizations, David Blumenthal, M.D., the HHS national coordinator of health information technology, attempted to encourage participation in the incentive program, noting that practitioners can effectively defer a meaningful use objective by claiming an exception, thus leaving them with fewer measures to satisfy initially.

Exceptions may be appropriate when a practitioner is not called upon to use specified EHR functions at the levels indicated in the measures during a reporting period, either because the function falls outside the practitioner’s normal scope of practice or simply because insufficient numbers of patients required or requested the function, he said.

However, Dr. Gross cautions that the HHS has not officially indicated the measures for which optometrists might appropriately claim exemptions.

Based on information provided during a recent presentation by Dr. Blumenthal to the American Academy of Ophthalmology, Dr. Gross believes there may be only a few circumstances under which optometrists might defer compliance by claiming exemptions from core meaningful use objectives:

• Computerized physician order entry (CPOE) and e-prescribing: Eligible providers (EPs) could opt out of CPOE and e-prescribing if they write fewer than 100 prescriptions in a 90-day reporting period, but still get credit for the measure.
• Electronic copy of health records: If no patients ask for an electronic copy of their health records during the 90-day reporting period, EPs can meet this core set objective as an exception and still get credit for the measure.

Allowing health care practitioners to initially defer five of the 10 menu meaningful use objectives under the program rule is one way the HHS has attempted to make the earning of incentives a realistic and achievable goal next year, the AOA Advocacy Group notes.

The AOA HIT Subcommittee is seeking clarification on additional core or menu meaningful use objectives for which optometrists may be able to defer compliance by claiming exceptions. The AOA HIT Subcommittee suggests optometrists frequently check for updates on the AOA Web site EHR page (www.aoa.org/EHR).