Most Favorite #3:  Increasing acceptance of delegation to trained para-professional staff.

When I was at ICO in the late 1980’s I was expected to provide an eye examination under the supervision of an attending staff doctor within about two hours.  We learned and then delivered every test under the sun — color vision, stereopsis, cover test, PD measurement, retinoscopy, keratometry, refraction, health testing — with incredible detail.  Not that there’s anything wrong with that, but I never really was trained on how this would change in practice.

Today, we use para-optometric staff, many of them trained at technical colleges and having attained CPOA or CPOT certification.  State laws dictating the “professional” practice of optometry historically limited an optometrist to a subset of test that such technicians could perform.  In current practice it is well established that ODs can and should use their trained staff to improve the quality and efficiency of patient care.  If you don’t use technicians today, you should start tomorrow.

Most Favorite #2:  Collegiality amongst competitors.

Sure, there are still rifts in optometry about modes of practice — private vs. corporate vs. employed by clinic groups and MDs.  But when optometrists from these various modes get together, invariably they are friendly and collegial.  It never fails to amaze me at local, state and national meetings to see doctors from very different backgrounds getting together and sharing clinical thoughts, and just enjoying each other’s time.

When doctors go to meetings where they further stratify themselves to cooperative competitors, which might be a gathering of doctors who practice in Walmart locations, or Lenscrafters, or private practices, they really get together.  It’s common for these doctors to all be in competition for the same patients, yet they gather to share perspectives on practice and ultimately help each other become better at what they do.

Most Favorite #1:  Technology advances in eye care.

Given the venture that I’ve made into EHR as a co-founder of a company that supplies web-based software to help ODs do the business of patient care, I guess that is plenty of evidence that I like technology.  The technology in optometry goes well beyond EHR, though.

We deliver care that goes well beyond that delivered just 10 years ago.  Macular pigment density testing, computerized eye charts, automated refracting systems, retinal imaging devices, high-tech tonometry — all make for a very exciting patient experience and a pleasurable day at work for an OD.

I could list dozens of my favorite things about optometry.  I hope that whatever drives you to continue caring for patients will continue to be a motivator for you to continue being a front-line eye care provider.

When doctors consider EHR technology, they don’t want to be anchored to a computer to care for a patient - we often hear about desires for user simplifications like touchscreens and voice recognition and portability of computers.  In the last month, I cannot begin to count the number of questions about EHR compatibility with the new iPad.  While it is not easy to appear against a cool new technology, EHR is best managed by sturdy, powerful desktop computers.

Practically, doctors do not think completely enough about the issues of office hardware when they adopt EHR.  When our web-based software product was new, we told doctors that all they needed was a PC or Mac with a 17″ monitor and a high speed internet connection, and that was a mistake.  While our original recommendation was true, the internal guts of the PC or Mac made a huge difference in user experience.  We evolved the standards to a point of “recommended” standards instead of “minimum” requirements.  Lots of memory (RAM), a large high-definition screen, a keyboard with a full numberpad, and a high speed processor significantly improve the user experience.  Rarely can you get those features in portable machines — laptops, tablets, and now, iPads.

Doctors think that their EHR implementation will be easier with a computer that can be carried under one’s arm like a paper chart, that can be placed on one’s lap to retain the traditional doctor facing position to the patient, and that allows the electronic record to be along for the ride no matter where the doctors goes.  But portability must be put well down the list of priorities when considering EHR hardware.

Here’s why:  data entry.  Portable computers do not provide as efficient data entry means as desktop computers.  Can you enter data on a tablet easier than a desktop computer because it has a touchscreen?  Some you can, some you can’t.  It looks cool to see someone demo EHR on a touchscreen but not all data is entered effectively in that way.  Can you enter data into an iPad easier than a desktop computer?  I don’t think so, unless you carry around a Bluetooth keyboard or buy a bunch of docking stations that include a keyboard.  And don’t forget about the other issues with portable devices — you have to plug them in to keep the battery charged and batteries do run down based upon intensity of use, and portable computers are at risk of breakage when dropped, and they are sensitive to Wi-Fi connection reliability and speed.

I’m telling optometrists to not be distracted by the stories about how great it might be to have an EHR on an iPad because the iPad does not yet offer easy data entry capability.  Doctors type into EHRs regardless of the number of dropdown menus, autofill fields, or other cool data fill features.  That means that data entry will need to be done by pecking on the iPad’s flat screen keyboard, which is nearly impossible.

Test it yourself; go to an Apple Store today and pick up sample iPad.  Hold it like you want to hold it while sitting on your exam stool - you’ll find it’s not a laptop device, so it needs to be put on the counter in the exact same place you’d put a desktop computer.  Then test the data entry capabilities — go to the Safari browser and type in www.mapquest.com and start typing in a search for directions from your home address to your office.  It’s an exhausting experience that will prove my iPad-is-not-for-EHR point.

When you are done testing an iPad, you might very well buy one for browsing the web or checking email at home.  But you will not come away thinking that an iPad is an efficient EHR device.  This geek believes there will be a day, but it’s not today.

January 22, 2010

Introduction and Commentary

Ever since the American Recovery and Reinvestment Act (ARRA) was passed into law in February 2009, health care providers in the US have been intrigued by the $17 billion that has been promised as incentive funds available to them for adoption of electronic health records (EHR).  Optometrists, like physicians, have not been quick to adopt EHR with under 20% currently using computerized recordkeeping in their exam rooms.  The federal government’s effort to positively influence more widespread adoption of EHR will have its intended effect, but there are so many variables for doctors to consider that confusion abounds and EHR adoption plans are not easily made.

Consider the promises that are being made by software vendors.  Some packages are being given away for “free”, although we all know nothing is really free.   Vendors have made promises of future software certification before their system is actually presented for certification inspection. Software companies are also promising compliance with yet-to-be-determined guidelines, along with implications that the system will allow a doctor to collect the future Medicare incentive payments when the truth is that the doctor’s use pattern of the software is truly going to determine payment qualification.

In essence, doctors are being pressured by these companies to believe that they must quickly choose a system in order to receive the forthcoming incentive monies.  Free offers, money back guarantees, doctors being advised that they buy ASAP or face the risk of not getting the bonus funds - these tactics represent hollow efforts by software companies to take advantage of the lack of knowledge of the facts by most practicing doctors.

There are few good sources of objective information about the federal stimulus funds, but through my effort to lead RevolutionEHR into the “meaningful EHR user era” I have attempted to be a sound, trustworthy source of information for optometrists.  With a new federal rule published on December 30, 2009, the facts laid out in the summer of 2009 have been supplemented by new details that should be digested by every optometrist who expects to receive funds in the next five years as a reward for their adoption of EHR.

Payment Details

Most health care providers have seen the matrix that shows the maximum possible payments that doctors can receive by becoming meaningful EHR users between 2011 and 2016.  For doctors who see substantive numbers of Medicare patients, the $44,000 total potential bonus payments will come in the form of five annual payments that are paid in decreasing amounts each year.

For the last six months, software companies have been suggesting that a doctor’s ability to collect all $44,000 is directly related to adopting EHR as quickly as possible.  Of course, doctors are not fully prepared for a proper practice analysis, market review and product comparison, so they feel unnecessary pressure to jump at perceived deals in the market.

The FACT is that eligible providers, a term that references a health care provider who is a participating provider in the Medicare system, will be able to apply for incentive fund qualifications and initiate their EHR meaningful use review as late as October 1, 2012, and still be eligible for all $44,000 of federal funding.  Doctors who feel pressure to purchase EHR today because of any software company’s misguided effort to push a doctor to a falsely urgent adoption deadline should be reassured that such pressure is somewhat artificial.  While it is true that doctors should be in some state of progress to EHR implementation, and the earlier adoption of EHR will allow the doctor ample time to learn the proper and efficient use of EHR, the receipt of ARRA funding is not wholly contingent on EHR deployment in some immediate timeframe.

Meaningful EHR User Review Period

The original meaningful use definition stated that an eligible provider will need to use a certified EHR system, perform e-prescribing, share data with other providers and systems, and provide quality reporting from the software. The non-profit EHR certifying body, CCHIT, and the federal government worked through the latter part of 2009 to overlay the EHR certification standards to the first draft of meaningful use guidelines.

The new rule published in December identifies a new phrase, “meaningful EHR user”.  The rule which is undergoing public comment through the first quarter of 2010 is 500 pages of detailed content that more specifically defines an eligible provider’s path to becoming a meaningful EHR user.  Within the rule, the government clearly discusses the scenarios that they contemplated on their way to their draft plan for a meaningful EHR user review period.

The new rule states that in a provider’s first year of use of a certified EHR system, the doctor may apply for qualification for funds based upon their care of Medicare or Medicaid patients.  Optometrists would need to have 30% of their patient population covered under Medicaid to apply for funds.  The doctor’s EHR use will be scrutinized for a continuous 90 day period within the first payment year, judging the user against the meaningful EHR user criteria.  If the doctor demonstrates meaningful use in that 90 day period, the first year’s EHR adoption bonus payments will be paid.  In subsequent years, the doctor will be judged on the entire year’s ongoing EHR use.

Thus, it is stated in the new rule that a user could apply for and begin their evaluation period for meaningful use on October 1, 2011, demonstrate such use, and be eligible for the bonus payment for the use through December 31, 2011.  Since the bonus matrix provides for the same $44,000 total whether a provider demonstrates first meaningful EHR use in 2011 or 2012, doctors truly have until October 1, 2012, as the last possible date to begin demonstration of meaningful use or risk not receiving some of the $44,000 total bonus pool.

Quality Reporting Details

The current Medicare PQRI process allows Medicare to better understand the details of the care delivered to patients with particular chronic, and costly, diagnoses.  Optometrists have been reporting on macular degeneration, diabetic retinopathy, and e-prescribing for over two years now with minor Medicare bonus dollars available for good PQRI code submission.

Until the new rule was delivered on December 30, there were no specialty-specific criteria for the quality reporting component of meaningful EHR use.  Details within the rule now are available for optometrists to generally understand the expected reporting that will need to come from their certified EHR systems.

The software will be configured to report particular codes about general and ophthalmic details of patient care services rendered by eligible providers.  Medicare will evaluate the proportion of services that include these details relative to the total number of Medicare patients seen in a time period.

-   General details for to be reported are:

1.  Preventive Care and Screening:  Inquiry Regarding Tobacco Use

2.  Blood Pressure Measurement

3.  Drugs to be avoided in the elderly — patients who receive at least one drug to be avoided; patients who receive at least two different drugs to be avoided.

For all three of these cases, this is the extent of the known detail of what is expected to be reported by a meaningful EHR user.

-   Ophthalmic details to be reported are:

1.  POAG Optic Nerve Evaluation — assessing the percentage of patients 18 years and older with a diagnosis of POAG who have had an optic nerve head evaluation during one or more office visits within 12 months

2.  Diabetic Retinopathy Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy — assessing the percentage of patients 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months

3.  Diabetic Retinopathy Communication with the Physician Managing On-going Diabetes Care — assessing the percentage of patients 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the on-going care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.

These are similar to some of the current PQRI reporting elements and have yet to be explained in further detail to equate their reporting by a meaningful EHR user.

Conclusion

Through the early part of 2010, there will continue to be very little clarity to the issue of meaningful use as the government wades through the 60 day comment period on the proposed rule for the EHR incentive program.  According to my contacts at CCHIT, they are in the process of performing a gap analysis to look for the differences between their current Preliminary ARRA 2011 Certification standards and the details within the newly proposed rule.     Software vendors that have already started the certification process of their optometry EHR system will need to undergo will need to have their system re-inspected.   Others will simply wait until the final certification details are defined.

This leaves providers on the outside of the process, looking in and wondering “how do I get my funding?”  The uncertainty that the doctors feel is related to the acceleration of EHR certification that has resulted from the ARRA’s $17 billion EHR adoption program.  To say it another way, the only reason that EHR adoption has become a hot button topic is the 2008 collapse of the American economy.  Had it not been for that disaster, EHR adoption by all health care providers would have progressed at a controlled pace.  There would have been ample time for certifying bodies like CCHIT to take the necessary time to convene workgroups for each health care specialty leading to Comprehensive certification standards for each specialty.  But with the ARRA, the vendors are left to scramble toward the fastest path to certification possible or face the possible rejection by doctors who will only buy systems that are seemingly on the cusp of certification.

It should be somewhat startling to optometrists that there has been no entity that has provided a real-time, “expert” analysis of the current state of the ARRA stimulus program.  This update is part of an ongoing effort by RevolutionEHR to help optometrists have a better grasp of the progress of the process.  ODs should monitor trusted resources for the latest information and are urged to ask detailed questions of their EHR vendor or prospective vendors.  One thing is true - there are no definitive answers today and anyone who poses with all of the answers should be challenged.  Many have claimed that early adoption is the key to meaningful use and stimulus funds, but more important than early adoption is thoughtful adoption. There is time for thoughtful adoption.

Look for additional information in the future as RevolutionEHR will continue to provide briefings and commentary.  Like every other upstanding EHR vendor in optometry, it is our absolute intention to achieve the proper EHR certification standards to allow our users to become meaningful EHR users.  Optometrists need to know that software certification is just the first part of the process to receiving ARRA funds, and that demonstrating meaningful use is what is ultimately required.  And that is something no software vendor can promise.

Least Favorite #3:  Dealing with the impact of insurance programs.

The impact of insurance programs on the practice of optometry cannot be considered without recognizing that patients go to the eye doctor because of their insurance coverage.  But the overall challenges of managing patient insurance causes a pretty big number of ODs to skip participating in plans or even leave plans after having been participants.  I have resisted participating in some vision and medical plans and recently have found that when local employers add coverage on a plan in which I am not a participant, they still visit our clinic for care when we tell them that we simply cannot join that plan.  We do risk losing product orders to local doctors who are on the panels, but our practice is predicated on delivering top-notch eye care so that doesn’t hurt as much as it would if we were product oriented.

Least Favorite #2:  Firing employees.

If you practice in a setting where you must manage or employ staff, one of the most miserable feelings is that associated with firing an employee.  When I reflect back on the termination of an employee, two things are typically true:  I waited too long to make the decision, and the individual is often relieved.  Your employee relationship can be somewhat parental, where the doctors serve a guiding role to the staff and they define and enforce the rules.  The difference is that there are times when the OD businessperson decides that there is no possible resolution of a staffperson’s skills, attitude, or performance.  My main advice to make firing an employee easy is to make it simple and don’t try to bring up the history of issues.  Use a simple statement:  “This simply is not working, and I think we both know the issues and each of our views of how things are going; but I would like to respectfully ask that you understand that we are going to discontinue our relationship effective now.”

Least Favorite #1:  Misunderstandings of optometry.

My wife knows what I do for patients, so do my kids and my parents and many of my patients who have been paying attention.  But for the most-part, the effort of organized optometry and individual optometrists has not yet moved the pendulum of understanding to really allow for full awareness of what we do.  Insurance companies, vision plans, bad marketing programs, and indifference are all at the root of optometrists not being fully understood for what they do.  We are all proud of our history of vision correction services and products, but we are still annoyed by the question, “don’t I need to see an ophthalmologist for that?”  Thankfully, our practice is wonderfully aligned with many tremendous ophthalmologists who know that we take our referrals seriously and that we will always send patients when the case exceeds our abilities.  Many times though we can do more than the patient believes.

Do you have other least favorite aspects of optometry?  Go ahead, get it out of your system.  Next time, we will discuss the top three.

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.

Most other health professionals talk about the location of their practice or their specialty ignoring the place that they practice:  hospitalist, primary care physician, cardiologist, physician assistant, nurse anesthetist.  There seems to be no implication that the practice of that professional’s area of expertise would be more or less professional based upon where the professional practices.  The field of medicine has evolved over the last three decades so private practice is not a significant differentiator anymore.

For optometrists, self-employment is still the majority status.  So it makes sense that we still stratify ourselves based upon the class-system that has been so common:  private practice (solo or group), corporate, employed by OMD, employed by HMO, military, academic.  As I see it these are not modes of practice, they are modes of payment for practice.

It can be argued that an OD in an academic institution practices differently than an OD at a WalMart, but in the end they are both following the SOAPE format while negotiating the patient care experience.  Same with the typical comparison between private practice ODs and corporately employed ODs — really, how are their practices different?  There are optometrists in Lenscrafters who have invested in more equipment than ODs who are self-employed, so what really differentiates their practices?

I recently heard from a doctor who has practiced nearly twenty years at a WalMart location where he essentially pays rent for a practice site.  Aside from being in the building, he is an independent optometrist who is free to see patients as he wishes, buy equipment he wants, and bill insurances that he desires.  There is no one dictating his practice, number of patients seen, or paying him.  He gets no revenue from lens prescriptions that he creates.  He feels that he runs a “private” practice and it’s hard to disagree with that.

Of course, optometrists have historically had the view that doctors who are located in retail sale-oriented locations cannot avoid the potential distractions of selling products for the owner of the location.  That further engrained the belief that corporately employed ODs were practicing less fully than ODs who wrote their own paychecks.  The reality is that most private practice ODs work very hard on the retail part of their practices and can get distracted from deeper delivery of patient care by focusing on optical retail sales.  There’s nothing wrong with that.

This is not a commentary against private practice optometrists.  I think that optometry is delivered in a very conscientious way when an optometrist signs one’s own paycheck.  The doctor decides the age of patients seen, number of patients per hour, and the fees that are charged based upon an introspective review of skills and business ideals.  Optometry has been a player in the health care arena in large part because so many ODs still make business decisions in the world of patient care for themselves.  That’s a very important point.

I don’t have a solution to fix the nomenclature of classifications of optometric practice.  We simply spend too much time trying to differentiate ourselves.  The public doesn’t understand optometry because the delivery of service from various optometrists is so different.  We should be loyal to our oath of practice taken at graduation, and to our professional license, moreso to any employer.

Anything you can do to make your commitment to patient care deeper should be your priority today.  If that means moving to a new practice location, buying a new computer program, hiring a staff person, or taking unique education — do it, regardless of your mode of practice.

Beyond tracking the practice’s income and expenses, today’s optometrist is challenged to know the business inside and out because of the critical decisions that must be made about involvement in managed care programs.  From local HMOs to national vision plans to Medicare and Medicaid, doctors face the never-ending task of trying to decide how low their fees can go in order to participate.

Most optometrists accept some managed care patients; some take many.  Those that are employed by managed care systems have their take-home pay tied to volume of patients, RVU generation, or some other equation that requires attention to detail.  Independently employed doctors have a more challenging analysis and, frankly, don’t have any good tools to help them know the bottom line impact of managed care.

There are consultants who can help by applying their machine to the analysis process.  These advisors truly have the success of the practice at their core.  They have acquired knowledge from experience in the industry and they apply it as specifically as they can after getting to know their clients.  But like every optometrist they serve, they have biases and it is critical that the doctor has a clear view of the path that is desired when contracting with a consultant.

Vendors of equipment, software, and wholesale products also offer advice.  Their biases are even more angled, which is fine as long as the doctor has that understanding.  Ophthalmic companies derive revenue from helping optometrists make revenue, so it is not necessarily a negative to take advice from them.  They only do well if you do well, but you must tread carefully with their advice if it overstates their value to you.

Recent examples of this have arisen in the EHR industry.  In light of the money that will be available in 2011-2016 from the federal stimulus act, some software companies have made the potential maximum dollars available look like a lot more than is really available.  How?  Well, Medicare already pays physicians (and optometrists) a small bonus if they report PQRI codes on a consistent basis.  The theory is that with software, doctors will be more likely to do quality reporting and thus will qualify for the bonus payments.

The rub is that the bonuses are paid on top of Medicare payments for services rendered, currently as a 2% addition.  The maximum PQRI payment for a doctor is $5,000 in a year.  To receive those dollars, you would have to receive Medicare payment of $250,000, and unless your fee schedule is at the rock bottom that Medicare pays, you would probably have billed 50-100% more than that for the service rendered.

That’s not very likely, and thus it’s really a stretch for a software vendor to say that use of EHR will land you that extra $5,000 maximum.  How many doctors know that?  Not many.

For that reason, you have to pay attention to your own practice metrics in order to be sure that you make smart business decisions.  You have allies in the industry to help you, and choose them wisely and listen to what they say carefully.  But validate anything you hear — just like you do when your technician measures IOPs on your glaucoma patients.

In absence of your careful attention, decisions that you make for your practice could be unwise.  Why let the system play you?  Take the pulse of your practice more carefully than ever… today.

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.

The days of stacked optometry journals on an OD’s desk are not gone.  The more common publications - AOA News, Review of Optometry, Optometric Management, and Primary Care Optometry News - continue to print periodic versions in addition to their online offerings.  Thousands of optometrists would admit, if pressed, that they have that dreaded pile of months-old journals sitting, waiting, for their attention.

So too do optometrists pile up the peer-reviewed publications that could make their professional judgments more evidence based.  The journals of the American Optometric Association and the American Academy of Optometry continue to publish the work of those in our profession that remain committed to the sciences of vision care and eye health.  There is no research project that proves that ODs do not delve into their scientific journals, but there are plenty of anecdotal stories to support the notion that far too many doctors avoid these publications.

The transition to electronic versions of optometry journals has likely been embraced as much as the same transition for traditional press offerings.  Online newspapers are certainly read by many but have not eliminated newspapers - reading on the computer is simply not the same as reading printed material both for content and for visual demand.  There is very little evidence that the printed medium is headed toward extinction as old habits are hard to break.

I have made the transition to reading most of my news online, and I have tried to read more journal offerings through their computerized versions.  But I find the process of registering for all of the publications to be a bit of a hassle, and I think that slows adoption even though it’s not the intended effect.  I bought a subscription to the Duane’s Clinical Ophthalmology resource a couple years ago that came in a case that looked just like a DVD case, but the great news is that the case only included a code to their web-based resource that is always up to date and accessible from any exam room at any time.  I love that.

I can envision a paperless world, free of all of the piles of professional journals.  Can you?

I have had my share of optometry mentors.  A couple of optometrists were friends of my dad and they advised me to attend a great little optometry college in the Windy City.  Another OD was the one that gave me the vision correction in middle school that showed me the power of the diopter (or two!)

I had great instructors at optometry school.  I’ve met a lot of ODs in the last twenty years who learned from legends who shaped their careers.   The influence of teachers can push both ways because there are times when a student clinician learns how to be outstanding, but there are others that teach one how to not care for patients.

I had “mentor” experiences in my student career that taught me tremendous lessons about the type of doctor that I did not want to be.  One was an ophthalmologist who would ask elderly glaucoma patients who reported medication non-compliance if they wanted to select the color of their seeing-eye dog before they went blind.  Another was an optometrist for whom I worked in a clinic, who treated his staff as though they were never meeting his standards for patient care.

But more importantly, I have had tremendous mentors that were positive influences.  I consider them all to be important people in my life.  One of my mentors recently lost his life in a battle with cancer that he fought valiantly.  I didn’t know Mike extremely well, but he was the optometrist in the hometown of one of my optometry school buddies and he became an optometry colleague during my career.

In my first experience, he opened his office to us before we took a state board licensing exam.  It was probably not a big deal to him, but to us it felt like we were being treated like princes.  Later, after I had become an optometry volunteer, I learned about how a person can lead without having to gain attention.  He served optometry and his patients well and unassumingly.  And he paid me the ultimate compliment - he referred his best friend to me as a patient.

I had a chance to thank him when he said goodbye to me the last time we were together, but it bears repeating:  Thanks, Mike.  I’ll commit to being like Mike, and I hope you do, too.

Do you have a great story about the outcome of your effort to mentor?  Let us hear it.