Most specialty providers have a general sense of the distance between where they stand today with ICD-10, and where they need to be when the ICD-10 transition officially occurs on October 1, 2015. The actual size of that gulf is largely a matter of the electronic medical record (EMR) in use. If the EMR will do all that it can (and should) to automate the transition, the ride to ICD-10 should be pleasantly smooth.

Earlier this year, research from the Centers for Disease Control and Prevention (CDC) showed that more than 78 percent of office-based physicians were using an electronic medical record. As physicians become increasingly familiar with EMRs, they are demanding more from their solutions to help them boost productivity. More often than not, they are looking for one main thing: mobility. According to research released by Black Book Rankings in May 2013, of the one-in-five physician practices surveyed that were considering switching their EMR vendor, 100 percent expected any new EMR to allow doctors to access patient data no matter where the care was being delivered.

Among all the focus on developing new technologies to aid healthcare providers, most clinicians will tell you the same thing: Healthcare still comes down to patient care and the patient experience. And the folks at the Centers for Medicare & Medicaid Services (CMS) believe that too, as evidenced by a significant update in the Meaningful Use Stage 1 requirements for 2014, which now include a core objective “to provide patients with ability to view online, download, and transmit health information for all providers.” That’s another way of saying providers now need to provide a patient portal in order to meet Stage 1. Instead of seeing this as yet another burdensome requirement that needs to be met, healthcare organizations should consider it an opportunity to improve communication with their patients. Further, Meaningful Use Stage 2 already has a significant patient engagement element requiring that providers show at least 5 percent of patients are using patient portals to view, download and transmit their health information as well as send secure electronic messages to their provider. While 5 percent may not seem like a lot, those providers who are now pursuing Stage 2 are significantly concerned about reaching those levels of engagement, so having a functional portal required earlier should make it easier to hit the minimum participation rate down the road.

With healthcare’s shift towards value-based reimbursement models and an emphasis on quality of outcomes over quantity of services performed, there is also a push for physicians to dig deeper into their reporting. In order to encourage improved quality measures reporting, the Centers for Medicare & Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS). The program, created in 2007, has both non-reporting payment penalties and reporting payment incentives for physicians who treat patients covered by Medicare Part B. Those who don’t participate in 2014 face a 2.0 percent payment penalty for Part B claims which will be assessed in 2016. Likewise, those who do report quality measures via PQRS are eligible to receive a 0.5 percent payment bonus on all claims in 2014. At first glance, the list of quality measures that can be submitted to PQRS is daunting, and many do not apply to specialty practices. Luckily for most specialty practices, the respective trade associations have done the legwork and have pulled out the applicable measures that can be used for submission. As such, specialty practices should check their association’s website for guidance in navigating the submission process.

One of the best ways to get physicians to adopt electronic medical records (EMR) is to ensure entering information in the system doesn’t disrupt their workflow. But for many physicians, sitting at the computer to type in notes during a patient visit is time consuming, causing many to feel that it detracts from the quality of care they provide. The icing on the cake? A recent report from IDC Health Insights shows decreased physician productivity after an EMR implementation due to workflow disruptions. One of the best ways practices can avoid these pitfalls is to look for EMRs that have integrated dictation capabilities. Many physicians make a voice recording of medical notes for transcription later and have been doing it that way for years. However, with integrated dictation capabilities, physicians are now able to add necessary notes to the EMR using only voice commands while meeting with the patient. This medical speech recognition technology accurately “types” the notes directly into the medical record in real time as they are spoken, rather than hours after the patient’s visit. The ease of adding notes in a manner that is consistent with the physician’s workflow fosters greater adoption and also improves practice efficiency.

Increases in copayments, deductibles and co-insurance rates over the past 10 years, as well as the increasing use of health savings accounts, have put a much greater emphasis on individuals taking an active role in how they purchase health services. In short, the age of consumerism has finally arrived for healthcare, but a greater question remains: Are healthcare organizations prepared for the patient-as-a-customer, and how do they positively engage these healthcare consumers to choose their practices over others offering the same services in a very competitive market?

One of several factors inhibiting ophthalmologists from adopting electronic medical record (EMR) systems has been the way Meaningful Use mandates were originally developed. In an article from Ophthalmology Times, titled “Eye-care professionals still slow to adopt electronic health records,” Dr. Chiang, chairman of the AAO Medical Information Technology Committee, offered the following comment: "The government's meaningful use programs are geared toward all health-care providers, for that reason, they inherently have somewhat of a one-size-fits-all approach, where the requirements that an ophthalmologist needs to meet are the same as what an internist or general surgeon would need to meet." However, the number of ophthalmology practices implementing EMR and practice management systems is growing due to the emergence of specialty vendors offering fully customized solutions using more advanced and flexible technology. The following are some best practices, tips and practical advice for ophthalmology practices that are trying to find EMR solutions to best fit their needs.

As many in the industry noted, Stage 1 Meaningful Use (MU) was largely geared toward general practices, and has been described as a “one size fits all” approach that did not take into account the varied nature of specialty providers. Although there were exemptions that specialty practices could qualify for in Stage 1, the initial confusion surrounding the guidance created challenges for many providers. CMS has now provided guidance on Core, Menu and Clinical Quality Measures (CQM) exclusions. CMS has been very clear that potential exclusions are not based on a particular specialty, but rather on the specific data that a practice does not collect because it is not relevant to their practice. They note that there are no “blanket” exclusions for any type of provider and that the physician is responsible for “evaluating whether they meet the exclusion criteria for each applicable objective.” After receiving numerous comments from medical societies, industry associations and other stakeholders, it seems that CMS is listening to the concerns that have been raised by specialty providers. With MU2, providers have more clarity regarding the process for reporting Core, Menu and Clinical Quality Measures. For example, CMS has published a Meaningful Use for Specialists Tipsheet.