As a practicing optometrist who has developed and launched a software platform, I have many reasons to be interested in the national discussion about software certification.  This opinion piece is not intended for promotion of my company or software system, but instead is aiming to help my colleagues in optometry get educated on software certification.

To be perfectly clear, the partial information and misinformation that is being delivered to optometrists by software companies is what has spurred me to write this open letter to optometry.  One need not look very far or hard to find all kinds of programs that suggest that the software companies are your best friends; examples include free software today in exchange for taking payment from your government subsidy later, full refunds if you can’t get government money, and guarantees that you will get payment starting January 1, 2011 if you buy product X.

The facts need to be clearly stated:

1.  No software company in optometry yet knows the path to certification.

2.  Doctors not only have to buy a software system to eventually get funds from the government, but they will have to prove “meaningful use” of that software for a period of time.

3.  Doctors will have to apply for governmental funds, and that will take time and there will have to be evidence of a pattern of proper use.

4.  The government agencies responsible for this program have not yet defined what meaningful use will be — see this article for an open letter from the governments lead health information technology expert just posted:

http://www.healthcareitnews.com/news/healthcare-it-chief-takes-meaning-meaningful

I was in Chicago last week to attend the “Get Certified for 2011″ conference that CCHIT hosted for software companies.  CCHIT is the not-for-profit entity that is expected to be a prominent certifying body for software systems.  I talked to their Executive Director and their Chairperson, and expressed to both of them the importance of establishing guidelines for optometry EHR software.  They have received input from the AOA, AAO, ASCRS, and others, and they recognize the need to look at “specialty” software as different than the guidelines they have today for ambulatory (outpatient) and inpatient (hospital) software.

Optometrists - realize that no one knows the answers at this time.  Don’t let any software company promise you the moon.  Every company has a hope and desire to become certified and to help you achieve “meaningful use” so you can get government money.  But this process has a long way to go to play out.  It is likely that no one is going to get money on Jan. 1, 2011 — the payment formulas, application processes, and payment dates are not even known.

In my view, the most significant concern at this point in the process is that there is very little clarity for certification of optometry-specific platforms.  The government will help define this better this fall as they consider specialties and CCHIT will make whatever effort necessary to develop a track to certification for eye-care only EHR systems.  Optometrists would be best-served if all of those with a stake in the process and outcome would come together:  AOA’s volunteers and staff who focus on health information technology, leaders of the software companies that fawn for optometrist customers, and optometrists who want to positively influence the outcome.  To date, such a cooperative effort has not happened because there is no unifying effort being made by anyone.  With this posting, I stand ready to serve in a volunteer capacity to coordinate such a group if I’m contacted.

For you, it is true that the sooner you implement an EHR from a company that has a competent plan to monitor and pursue certification, the better off you will be.  But please understand these variables for optometry-specific software and feel free to critique company claims and ask tough questions.  The best answers you should expect to get are along the lines of “no one knows for certain but we sure are going to work hard to help our optometrist customers get their share of the federal funds.”  If you want to poke at my commentary or ask me for more details, feel free to post a comment.

In the next few months, America’s health care providers will be inundated with facts and even myths about the federal government’s economic stimulus plan and its impact on adoption of health information technology.  The dual reality that I live, as a practicing optometrist and a CEO of a new EHR software company, tells me that many more details need to unfold before an optometrist will know the financial impact on his or her practice.

The American Recovery and Reinvestment Act (ARRA) that was passed by Congress in February stipulates that nearly $20 billion will be delivered to health care providers as they implement health information technology in their care of the patients.  No one yet knows the formula for how the money will be distributed, but there are a few facts that have equally concerning, associated unknowns.

The funds will be delivered to doctors as a result of their “meaningful” use of an EHR system.  That is defined as use of an EHR that has integrated e-prescribing, as well as capability to enable improved health care.  These are important standards.  The problem for optometrists is determining how the health system will accept information about our patients that we deem critical - visual acuity, intraocular pressure, phoria, C/D ratio - some entity will need to address this.  In my exploration of the matter, I have found that AOA is making every effort to assure that optometry will be represented in this process.

Also, the funds will not be delivered in the form of a tax credit or check written to a software company to offset the cost of buying an EHR program.  The only recipients of funds will be doctors who participate in the care of Medicare or Medicaid patients, as there is already a conduit for doctor payment through those programs.  So doctors who are not helping to care for America’s citizens who are covered under such programs are on their own, and they will not be able to apply for funding to offset their EHR cost.  I’m ok with that, and I applaud the government for their stance to compel ODs to care for patients with governmental coverage.

It would be impossible to cover all of the topics associated with the health information technology stimulus funds, but the most interesting of all of the components is this:  funds will be available for those who implement EHR by 2015, and if you don’t do anything by then, there is nothing in it for you.  A maximum benefit of up to $44,000 paid over five years between 2011 and 2016 can be a significant boost to the health care system’s use of EHR as it truly improves the accuracy and completeness of patient care.  There’s no push to get EHR today, but there’s really no reason to wait.