Software Solutions/EHR

Get Stage 2 Meaningful Use-Ready: Incorporate Medical Imagery in EHR

By Joe Ellis, OD

Many ODs still are wading through Stage 1 of the federal government’s electronic records incentive program. Now it’s time to address Stage 2 Meaningful Use requirements by incorporating medical imagery into your EHR.

If you’re still just getting used to the idea of making your newly implemented electronic records software a part of your office protocol, it may be time to take it to the next level. Once you master the federal government’s EHR incentive program’s Stage 1 of Meaningful Use standards, you will be expected to work toward meeting Stage 2 requirements. Chief among those requirements is the need to add medical imagery from instrumentation into the software. ODs who attested to Meaningful Use Stage 1 in 2011 or 2012 will need to start incorporating imagery into their EHRs in 2014.

These images will be stored “in the cloud,” meaning a data platform that exists online rather than on a piece of software or hardware. Specifically, they will be stored on the AT&T Synaptic-Storage-as-a-Service platform, which is ISO 27001 and HITRUST-certified.

Tools to Aid Your Transition to EHR:
Introducing XNetwork

AOAExcel, a wholly owned subsidiary of the American Optometric Association, is leading the way in patient care with a new innovative Health Information Exchange and Practice Support Network, available March 2013.

XNetwork is a powerful selection of cloud-based healthcare applications intended to drive doctor productivity, improve patient care and connect doctors to the broader healthcare community. The portal, powered by AT&T Healthcare Community Online, has many benefits and features:

Benefits
• Vendor-neutral experience, giving doctors and administrators a high level of flexibility in selecting applications.
• Value-add services on top of traditional health information exchange functions.
• Streamlined workflow and quicker access to relevant patient data.
• Supports meaningful use by enabling the exchange of patient records and user authentication to certain pre-integrated certified applications.

Features
• Cross-system presentation of patient records, including medications, alerts, clinical documents, lab results, clinical statistics, problems, procedures and images.
• Rich integration with practice management systems (PMS) for patient demographics and appointment schedule.
• Customer administration and control of user access, privileges, content and presentation of clinical information.
• Pre-integration, including single sign-on (SSO) access to a catalog of best-of-breed health IT.

For more information, visit www.excelod.com/toolkit.

Getting from Stage 1 to Stage 2

During Stage 1 of Meaningful Use (2011 and 2012), eligible providers must meet 20 of 25 objectives. Some 15 core measures must be met, as well asfive additional measures that can be selected by each ECP from a menu set of 10 measures. You must also reportsix Clinical Quality Measures (CQM), includingthree core andthree additional measures chosen from a menu set of 38 additional measures. You can download a list of these CQMs here.

Many of the requirements for Stage 2 are similar to those in Stage 1 with an expanded scope. One of the most relevant new objectives for optometrists is that they will need to begin incorporating imagery from scans or ordered tests into their EHRs. This is particularly relevant because optometrists and ophthalmologists are second only to radiology in image intensity capture. And, as of now, most images are captured and stored in-house. Click HERE to download a free PDF with an itemized list of Stage 2 requirements.

Incorporate Medical Imagery in Health Exchanges with Other Doctors

Health Information Exchanges, or sharing e-files with other doctors as a way to co-manage patients, is a key strength of electronic records. The focus in Stage 1 of Meaningful Use was mainly on the transfer of data, but one of the major pieces of data used in helping to diagnose patients is medical imagery.

In sophisticated health information exchanges, medical images can be sent in second and third formats, and they can be used for side-by-side comparison purposes. Doctors can make notes on the images for their colleagues to see, or they can send an invitation to have a real-time session to review the imagery together. In some exchanges, doctors would be able to send invitations to a few hundred colleagues. This is a great teaching tool for optometry students. Optometrists can have access to all images, not just ophthalmic images, and they can look at those before the patient arrives. Since the images are stored in the cloud, they wouldn’t need to store them. And, due to FDA approval, they can be viewed anywhere, even from mobile devices.

Why the Need to Incorporate Medical Imagery

When you send imagery taken from diagnostic instrumentation to your EHR and then transmit it to other eyecare professionals, other healthcare providers and other healthcare facilities, you are doing more than meeting Meaningful Use requirements–you’re adding to the efficiency and cost-effectiveness of the healthcare system. According to AOAExcel XNetwork partner AT&T Healthcare Community Online, medical imaging in the US is growing exponentially:

• Medical image archives are increasing by 20 percent to 40 percent each year. It is projected that by the end of 2012, there will be 1 billion medical images stored in the US.

• It is estimated that medical imaging information storage constitutes one-third of global storage demand, which, in 2007, was the equivalent of 1.2 billion average hard drives.

• The sheer number of images ordered by physicians has exploded in the past 15 years. One study showed that the number of MRI units more than doubled between 1995 and 2004, while the number of CAT scan units grew more than 50 percent.

Intersection of EHR and OD’s Office

I had two recent experiences that illustrate the advantage e-sharing of medical imagery will bring to all doctors. Just two weeks ago, I had a patient, a young boy, who was shot below the eye with a BB gun. The boy went to an emergency room two hours away from home. The emergency room doctor told the family to get him to an eye doctor soon. The family didn’t show up in my office until three days later. By that time, the boy had a hemorrhage in his eye from the initial impact. I tried to look for the BB pellet via a physical exam. I asked the family if the child was given a CAT scan or an X-Ray in the emergency room. They couldn’t remember. So, I had to re-order X-Rays at the local hospital and it delayed care. I found out a week later that the other hospital had previously done the tests, a full week earlier.

In another recent incident, I was called for an ER visit on a Saturday afternoon. The patient had a history of glaucoma suspect, uncontrolled diabetes and signs of diabetic retinopathy, as well as stages of histoplasmosis. The emergency room physician was concerned about possible angle-closure glaucoma. Fortunately, angle-closure glaucoma was not found, but I was highly suspicious of glaucoma. There was no way to get any ophthalmic images taken by her regular doctor on such short notice, so I had to start doing evaluations and make decisions based on present time information and didn’t get records until three or four weeks later. All this inefficiency meant I had to do redundant testing. It is this kind of duplicate testing that is increasing the cost of healthcare for all of us. More importantly, it also detracts from the timeliness and the quality of healthcare that our patients expect and deserve.

When nearly all healthcare providers are equipped with electronic records that house medical imagery, there will be no need for the duplicate testing and inefficiency of these two scenarios.

Resources

Click HERE to download a free white paper on medical imagery in electronic records by AOA XNetwork partner AT&T.

Related ROB Articles

EHR-Enabled Co-Management: Improving Patient Care

Boost Efficiency: Connect Your EHR to Your Other Software

EHR: Create a Successful “Meaningful Use” Practice

Joe Ellis, OD, is AOAExcel chair and past president of the AOA. He also is a partner of Eyecare Associates of Kentucky in Benton, Ky. He can be reached at: jeellis@aoa.org

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