EHR-ready

Create an EHR-Ready Practice

If you've made the commitment to acquire an electronic health records system, it's time to establish implementation plans.

Scot Jens, O.D., F.A.A.O.
Middleton, Wis.

Although optometrists can participate in the Centers for Medicare & Medicaid Services EHR Incentive Program by purchasing and utilizing an Office of the National Coordinator-Authorized Testing and Certification Body Certified EHR technology, every staff member and doctor in the practice must become familiar with the functionality necessary to achieve EHR Meaningful Use (MU) in order to receive the incentive.

While it's true that the program specifies that MU is related to the Eligible Professional, or EP, which is the doctor,* the entire staff's actions can determine the success of the MU process as well as the efficiency with which the practice smoothly transitions to EHR.

For 2012, as in 2011, any doctor who is in the first year of eligibility only needs to identify 90 consecutive days of MU with the Certified EHR software to be eligible for the incentive. (Articles on MU criteria appear in the October 2010, January 2011 and July 2011 issues of Optometric Management, which are available at www.optometricmanagement.com.)

The following checklists define the processes that practices will require to become EHR-ready.

Thirty days in advance

Undertake the following preparation steps 30 days prior to beginning MU demonstration:

■ Review the EHR software security capabilities by:

► Creating unique user name and password controls for every employee.
► Defining standards by which employees log in and log out to meet HIPAA standards for protecting patient information.
► Understanding the EHR software access log and audit log capabilities and reviewing the logs as needed.

■ Schedule three staff meetings to discuss these topics:

1. committing the team to MU standards. Prepare everyone for their mutual commitment to consistent software use and data entry, while explaining the key history, exam and post-exam processes that will be expected (see forthcoming checklist).
2. Preparing for sensitive actions and plans. That is, instruct staff to capture patient race and ethnicity, take vital signs, such as weight measurement, and assign key employees to work as facilitators for other staff to periodically report to the entire staff on progress toward the goal of successful data documentation.
3. Preparing to go live. Discuss the overall intent of the practice to improve patient care in order to gain government funds to improve IT infrastructure and to offset software cost. And, clearly outline the intended 90-day date range for planned MU review.

■ Develop strategies, and implement actions to accomplish these patient processes:

► Documenting e-mail addresses for all patients, especially for patient communications, use in patient reminders and for future access to any online patient health record portal that may be used by the practice.
► Educating new patients who were referred to your practice to bring a current medication list or clinical summaries from a referring doctor or from their primary care provider (PCP) or health specialists.

■ Purchase equipment, including:

► A commercial grade scale for weight measurement.
► A height-measuring device.
► A blood pressure-measuring device (auto-sphygmomanometer; manual sphygmomanometer and stethoscope; child and large adult options may be considered).

■ Implement a software setup process.
■ Familiarize all front desk personnel and opticians with patient demographic data collection procedures, including preferred language, race and ethnicity.
■ Develop software rules to deliver proper patient education and to sufficiently utilize the software's clinical-decision support processes.
■ Develop an e-prescription plan. This should include:

► Having drug-drug and drug-allergy interaction checks available for the entire reporting period and assessing the EHR's drug-formulary capability for best use.

Once preparation is complete, consider the following five action plans:

ACTION PLAN: interviews and case history

■ Document demographic details for every patient: preferred language, race and ethnicity.
■ For any patient referred to the practice/provider, document referring doctor information, and manage the transition of care by documenting any information from patient-supplied clinical summary documents, such as performing appropriate medication list reconciliation.
■ Review and document patient self-reported medications in a master medication list.
■ Review and document all patient self-reported medication allergies and non-medication allergies.
■ Review and edit the master problem/diagnosis list, and document any history related to the patient's complaint.
■ Review and document patient tobacco use and smoking status.

ACTION PLAN: doctor examination

■ Capture vital signs, as indicated by patient case presentation; periodically, based upon risk factors.
■ Review all master lists (i.e. (medications, medication allergies) with the patient for accuracy.
■ Add diagnosis coding for any condition to master diagnosis/ problem list, especially ICD-9 or SNOMED codes.
■ Enter medication prescriptions, which should be entered through computerized provider order entry instead of paper prescriptions.
■ Understand and utilize your e-prescription software's special capabilities, including drug-drug, drug-allergy and drug-formulary checks.
■ Analyze and act upon any clinical-decision support alerts.
■ Analyze and act upon any patient-education alerts.

ACTION PLAN: post-examination

■ Generate and deliver clinical summary documentation for appropriate examinations, especially when the doctor prescribes new medications for the patient.
■ Generate a diabetes encounter summary letter to the PCP for any patient who has a documented diagnosis of diabetes.
■ Create an appropriate referral for any patient who is being transferred to an external provider, generate a record summary, and deliver it to the referral doctor.
■ Create patient login access to an online patient portal (if available) to aid in patient timely access to their electronic health information.

ACTION PLAN: general steps

■ For any clinical laboratory tests ordered by the optometrist, document the results in the EHR.
■ Generate any patient list that can be used to improve the health status of your patients by delivering customized communications. Sort the list by attributes, such as diagnosis codes, medications, allergies and/or lab results.
■ Prepare to provide an electronic copy of a record summary to any patient who requests it. Deliver it as a PDF via secure e-mail; copied onto a flash drive; a CCR document (when sent to another EHR system), or provide it via an online patient portal.

Special attestation actions

■ Prepare for and perform a test of the EHR software's capability to electronically exchange information.
■ Generate a clinical quality measures report for use during the attestation process.

The 90-day analysis

Estimate the beginning of the 90-day period based on the readiness of the staff and doctors in the practice. For example, if you select a system on April 1 and can finish training by August 1, aim for having the MU plan in place by mid-September, so the 90-day MU period ends before December 31 — the final day allowed for a year's MU 90-day period.

Then, during the MU period, analyze the EHR software's MU reporting system every week in the first month of the presumed 90-day period. If the practice's statistics show reasonable compliance with the MU Core objectives, the estimated starting date should be considered by all clinic personnel as the date that will be used to peg the end of the 90 days. Re-check the MU report during the middle and end of the second month to confirm compliance.

In the final month of the 90 days, it is critical that the staff who were appointed as the MU leaders track the MU report every 10 days to assure each staff person and doctor of the progress of the statistics. The information shared should re-focus the practice on compliance with objectives that are not being reasonably met, so as to allow the practice to have a track to a successful 90 day MU period.

On the outside chance that the practice's statistics are not tracking well in the first two months, a new targeted start date can be assessed to allow for compliance with the 90-day period. If this occurs, ignore the unsuccessful MU efforts from that initial start date.

Success = all hands on deck

The key to an EHR-ready practice is a mentality that everyone in the practice is responsible for complying with the MU standards while utilizing the EHR software to take excellent care of patients. Once you select a software system and the training process begins, it is imperative that the MU process begins in earnest. This allows for proper planning for the pre-MU period planning and a successful 90-day MU period.

Front desk personnel can assist the MU process even when the patient is not in the practice. For example, they can document the patient's full demographic profile during phone conversations, remind patients of the need for them to bring their medication list to appointments, and assist patients with their access to online patient portals as needed.

Those opticians who interact with patients at any time, should review the entire EHR to document any patient data that changed since a recent visit or to document data for the first time. At minimum, establish a communication plan that assures that patient data gained by the optician can be properly directed to a technician or front desk employee for documentation.

You, the doctor, are the center of the MU process, and a strong sense of commitment and an established leadership position will give the practice the readiness that is needed to achieve MU. MU is more than buying and using a Certified EHR technology. By using the checklists provided, you can design a successful MU plan for the motivated optometry practice. OM

* A Doctor of Optometry is considered an EP in the Medicare version of the program, but for the Medicaid version of the program, the optometrist's state Medicaid program must create that definition.

Dr. Jens has practiced for two decades and has volunteered for state and national optometry associations. He is cofounder and CEO of an optometry EHR company. E-mail him at sjens@revolutionehr.com, or send comments to optometricmanagement@gmail.com.