Eyeworld

EW MEETING REPORTER January 2011 129 medication orders, implementing drug-drug and drug-allergy interac- tion checks, prescribing medicine electronically, recording patient de- mographics, maintaining an up-to- date problem list of current and active diagnoses, maintaining active medication and medication allergy lists, recording and charting changes in vital signs, recording smoking sta- tus for patients 13 years of age and older, implementing one clinical de- cision support rule, being capable of exchanging clinical information electronically, reporting clinical quality measures to CMS or to the state, providing patients with an electronic copy of their health infor- mation, providing patients with clinical summaries for each office visit, and implementing a system to protect the privacy of patients and security of their data in the EHR. There is an exclusion to record- ing vital signs, Ms. McCann said. "You just have to attest that this is not within your scope of practice in ophthalmology," she said. Practitioners then have to meet five of the 10 menu set of meaning- ful use measures, with one stipula- tion—they must select one of the population/public health meaning- ful use criteria from the menu set as one of those five. Those include in- corporating clinical laboratory test results into EHRs as structured data, generating lists of patients by spe- cific conditions to use for quality improvement, reduction of dispari- ties, research, or outreach, using EHR technology to identify patient- specific education resources and pro- vide to the patient as appropriate, providing medical reconciliation be- tween care settings, providing a summary of care records for patients referred or transitioned to another provider or setting, submitting elec- tronic syndromic surveillance data to public health agencies, sending reminders to patients for preventa- tive and follow-up care, and provid- ing patients with timely electronic access to their health information, among others. The latest informa- tion on EHR meaningful use and certification can be found on the ASCRS website, www.ascrs.org/ government-relations/emr.cfm. Within the 15-core meaningful use set, CMS has finalized the require- ments for reporting calculated re- sults for core quality measures as well. If patients do not fit the three core or three alternate clinical qual- ity measures, the provider has an ad- ditional menu set of 38 measures to pick from, four of which are oph- thalmology specific. Beginning in 2011, practitioners can earn incentive payments for adopting the technology and prov- ing meaningful use, although the payments will go down as the years progress. On January 3, the Office of the National Coordinator for Health In- formation Technology passed the final regulation for establishing a permanent certification program for health information technology. A list of certified vendors for meaningful use is available at www.asoa.org. "It's important to look at the version that is certified on the list," advised Tina Pinke, C.O.T., C.O.E., practice administrator, Pinke Center for Eye Health, Shelton, Conn. Also, "don't buy because of the incentive VISIONBLUE TM (TRYPAN BLUE OPHTHALMIC SOLUTION) BRIEF SUMMARY OF PRESCRIBING INFORMATION Indications and Usage VisionBlue TM is indicated for use as an aid in ophthalmic surgery by staining the anterior capsule of the lens. Contraindications VisionBlue TM is contraindicated when a non-hydrated (dry state), hydrophilic acrylic intraocular lens (IOL) is planned to be inserted into the eye because the dye may be absorbed by the IOL and stain the IOL. Precautions General: It is recommended that after injection all excess VisionBlue TM be immediately removed from the eye by thorough irrigation of the anterior chamber. Carcinogenesis, mutagenesis, impairment of fertility: Trypan blue is carcinogenic in rats. Wister/Lewis rats developed lymphomas after receiving subcutaneous injections of 1% trypan blue dosed at 50 mg/kg every other week for 52 weeks (total dose approximately 1,250,000-fold the maximum recommended human dose of 0.06 mg per injection in a 60 kg person, assuming total absorption). Trypan blue was mutagenic in the Ames test and caused DNA strand breaks in vitro. Pregnancy: Teratogenic Effects: Pregnancy Category C: Trypan blue is teratogenic in rats, mice, rabbits, hamsters, dogs, guinea pigs, pigs, and chickens. The majority of teratogenicity studies performed involve intravenous, intraperitoneal, or subcutaneous administration in the rat. The teratogenic dose is 50 mg/ kg as a single dose or 25 mg/kg/day during embryogenesis in the rat. These doses are approximately 50,000- and 25,000-fold the maximum recommended human dose of 0.06 mg per injection based in a 60 kg person, assuming that the whole dose is completely absorbed. Characteristic anomalies included neural tube, cardiovascular, vertebral, tail, and eye defects. Trypan blue also caused an increase in post-implantation mortality, and decreased fetal weight. In the monkey, trypan blue caused abortions with single or two daily doses of 50 mg/kg between 20th to 25th days of pregnancy, but no apparent increase in birth defects (approximately 50,000-fold maximum recommended human dose of 0.06 mg per injection, assuming total absorption). There are no adequate and well-controlled studies in pregnant women. Trypan blue should be given to a pregnant woman only if the potential benefit justifies the potential risk to the fetus. Nursing mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when trypan blue is administered to a nursing woman. Pediatric use: The safety and effectiveness of trypan blue have been established in pediatric patients. Use of trypan blue is supported by evidence from an adequate and well-controlled study in pediatric patients. Geriatric use: No overall differences in safety and effectiveness have been observed between elderly and younger patients. Adverse Reactions Adverse reactions reported following use of VisionBlue TM include discoloration of high water content hydrogen intraocular lenses (see Contraindications) and inadvertent staining of the posterior lens capsule and vitreous face. Staining of the posterior lens capsule or staining of the vitreous face is generally self limited, lasting up to one week. Rx ONLY Revised: July 2005 Manufactured by: © Dutch Ophthalmic Research Center International b.v. Scheijdelveweg 2, 3214 VN Zuidland The Netherlands Distributed in the United States by: Dutch Ophthalmic USA 10 Continental Drive, Bldg 1 Exeter, NH 03833, U.S.A. Phone: 800-75-DUTCH or 603-778-6929 U.S. PAT. 6,367,480; 6,720,314 continued on page 130

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