Sunday, November 7, 2010

Disruptive Luddites


For Ophthalmology Times:

The past year has seen a rapid acceleration and implementation of electronic medical records in medical practices. While some ophthalmologists long ago installed EMR it was for the reason of establishing a reliable medical record, and also to improve the efficiency of their practices, improve reimbursement and eliminate paper. Most ophthalmologists lagged in EMR usage due to lack of affordable solutions and the fear of disruptive technology.

During the second and rapid phase of adoption of new technology we have gone beyond 'early adopters', and the remainder of ophthalmology is adopting for political/financial incentives or social influence. Social influence plays a large role in the selection process of the EMR. Ophthalmologists and many physicians rely upon social medical peers for their demonstrations and testimonials regarding EMRs.

Like it or not in the next two years most of us will have adopted EMR and HIE (health information exchange), and not for just financial reasons. Instead of investing in that 4th generation OCT, or Wave front analyzer you will opt to buy an EMR, for which you will be at least partially reimbursed. (and most likely more than a charge for an OCT or Wave front calculation. The smart money will go toward EMRs. In most specialties the reimbursements are being bundled, and the ROI or recapture of investment will be much less than the incentive for purchasing an EMR.

We will increasingly see that referral sources require electronic communication with specialists, and will expect consultation reports to be sent electronically, via the health information network(s). This will take some time to establish, but it is inevitable.

Like my analogy on the Health Train Express....move over or get run over! It is a bit like the negative effect of not adopting a disruptive technology. By not adopting a growing technology you will be at a disadvantage in the market place, which will more than disrupt your practice than if you had adopted EMR.

John Hamlaka MD, who is the CIO at Harvard makes the following observations.

“The ONC is concerned about the success of meaningful use Stage 1, “and if it turns out much of America can’t achieve meaningful use Stage 1, then more rigorous criteria are not a good idea,” he said. The ONC is expected to further refine the requirements and do a second-quarter 2011 checkpoint to see how it’s going.
Stage 1 programs start in January, attestation will begin in April, and the first incentive dollars will be awarded in May, Halamka said. “The implication for many of us is that you better make sure you have the capacity to do all these quality measures January through March, 2011.

“In some ways, quality measures as they exist are process measures,” said John D. Halamka, MD, during his closing keynote HIMSS Virtual Conference presentation.

Stage 2 will see the introduction of outcomes orientation, and Stage 3 will move to outcome measures, which measure the wellness of a patient instead of how many tests were ordered for a given patient, said Halamka, an emergency room physician and CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the U.S. Healthcare IT Standards Panel (HITSP) and co-chair of the

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